PMC6293594_01
(a) Head computed tomography (CT) scan prior to the first surgery. A high-density calcification associated with a lipoma is seen in the frontal interhemispheric fissure. Swelling is also observed in the brain parenchyma surrounding the lesion. (b) Head CT-scan after the first surgery. The calcification and perifocal edema have resolved
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F1
The mass had signs of calcification, and it was surrounded by low-density lipomas [Figure 1a]. After surgery, CT scan revealed that the edema in the right frontal lobe had resolved [Figure 1b].
Initial magnetic resonance imaging. (a-c) A low-intensity area is seen on T1- and T2-weighted and fluid-attenuated inversion recovery images. (d) Gadolinium-enhanced T1-weighted images reveal a high-intensity area around the rim of the mass and edema in the right frontal lobe parenchyma
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F2
Moreover, edema was observed in the right frontal lobe parenchyma [Figure 2].
(a) Head computed tomography (CT) scan prior to the second surgery. Three high-density mass lesions are observed in the frontal interhemispheric fissure. Swelling is also observed in the brain parenchyma around the lesions. (b) 3D CT angiography reveals an area of calcification surrounding the anterior cerebral artery
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F3
Head CT-scan revealed three highly dense mass lesions in the frontal interhemispheric fissure [Figure 3a]. CT angiography indicated that the lesions surrounded the anterior cerebral artery (ACA) [Figure 3b].
Intraoperative photographs obtained during the second surgery. White calcified mass surrounding the artery in the interhemispheric fissure. *Branch of anterior cerebral artery
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F4
ACA from distal to proximal in the interhemispheric fissure and identified a calcifying mass lesion surrounding the ACA [Figure 4]. A lipoma was found near the lesion.
(a) Head computed tomography (CT) scan after the second surgery. Three high-density masses are removed without residual calcification. Edema around the lesions is reduced. (b-d) Head CT-scan 14, 18, and 24 months after the second surgery. A small high-density mass observed in the frontal interhemispheric cistern again. The mass lesion has grown to approximately 3.5 mm in diameter, and the size remains the same
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F5
Postoperative head CT-scan confirmed the absence of all calcifying masses as well as reduced brain edema around the lesion [Figure 5a]. The lesion was approximately 3.5 mm in diameter, and the size remained the same for 2 years [Figure 5b-d].
(a) Specimens obtained during the second surgery. A strong nodular calcification observed in small vessels. Epithelioid or spindle cells are also observed at the margin of the nodule [hematoxylin-eosin (HE) staining x40]. (b) Specimens obtained during the first surgery. Multiple calcifications are observed in the brain parenchyma (HE staining x40)
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F6
No malignant change occurred [Figure 6a and b].