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The MRI of the first tumour suggestive for a high-grade glioma. A) T2WI - the tumour is surrounded by vasogenic oedema. B) T1 WI - a ring enhancement around an area resembling necrosis with peripheral irregular enhancement
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However, in subsequent magnetic resonance imaging (MRI) a tumour in the rear part of parietal lobe was shown (Fig. 1A-1B).
The control CT images after the first tumourectomy. A) After two weeks. An oedema with haematoma along with air bubbles can be seen. B) After two months. The residuals of the tumour can be seen
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The T2 WI showed that the tumour was surrounded by a vasogenic oedema. The patient underwent a subtotal cranial tumourectomy; however, only a small part of the tumour was recovered for histopathological examination (Fig. 2A-2B).
Images of primary (A-E) and recurrent (F-H) tumours. A) Angiocentric pattern in H&E. B) Ki-67 index below 5%. C) Small areas with Ki67 index of 5-10%. D) Dot-like epithelial membrane antigen (EMA). E) Diffuse EMA staining. F) Reaming angiocentric pattern. G) Microvascular proliferations and cellular atypia. H) Focal necrosis and residual angiocentric pattern
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The Ki-67/MIB-1 labelling index was low - up to 5% (Fig. 3B). These features vouched for the diagnosis of angiocentric glioma (Fig. 3A); however, small foci of higher cellularity were found. In these areas, the tumour cells presented distinct nuclear atypia and a higher Ki-67/MIB1 labelling index of 6% to 8%, which indicated on higher grade (Fig. 3C). The first was diffuse and the second was dot-like and highlighted microlumens (Fig. 3D). There were fields with characteristic angiocentric features that corresponded to those of the primary tumour, but the neoplasm lost the expression of EMA (Fig. 3F). Additionally, there were unequivocal glioblastoma areas with necrosis and microvascular proliferations (Fig. 3G-3H).