PMC9800869_01
Radiological images of the primary lesion. (A-C) Axial T2-weighted, axial T1-weighted and coronal T2-weighted MR images show a large, heterogeneous, left lateral ventricle compressing mass and mild perilesional edema in the left frontal lobe. Hemorrhagic appearance is observed in the posterior-inferior part of the mass (hyperintense signal on T1-weighted and T2-weighted images). (D) There was no enhancement in the mass on the Gd-enhanced T1-weighted MR image.
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No contrast enhancement was observed in the mass on post-contrast MR images (Figure 1).
Sagittal T2-weighted (A,B) and post-contrast T1-weighted (D,E) MR images demonstrate multiple metastatic lesions with contrast enhancement between T11-L1 levels (long arrows) and around cauda equina roots (arrowheads). Axial T2-weighted (C) and post-contrast T1-weighted (F) images at T12 level show an extramedullary metastatic lesion compressing the spinal cord.
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T11-L1 levels and multiple enhancing tumor deposits attached to cauda equina roots between L4-S1 levels (Figures 2A-F).
Pathological findings. (A) Microscopic examination (H & E, x400) showed small-medium sized tumor cells with round nuclei and perinuclear haloes. (B) GFAP was diffusely positive in tumor cells. (C) Immunohistochemistry for IDH-1 R132H was positive (mutant). (D) ATRX immunohistochemistry showed retained wild-type expression. (E,F) 1p19q-codeletion in oligodendroglioma via fluorescence in situ hybridization. (E) 1p deletion of oligodendroglioma tumor cell nuclei (two green signals for 1q25, one red signal for 1p36). (F) 19q deletion of oligodendroglioma tumor cell nuclei (two green signals for 19p13 and one red signal for 19q13). Red arrows showed cells with deletion, and green arrows showed cells without deletion.
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Vascular endothelial proliferation was absent (Figure 3A). IDH-1 (Figures 3B,C). Immunohistochemistry for ATRX showed retained wild-type expression (Figure 3D). Fluorescence in situ hybridization studies revealed 1p/19q co-deletion (1p/1q ratio 85%, 19q/19p ratio 65%) in tumor cells (Figures 3E,F).