PMC5835125_01
The left forehead adjacent to the cerebral falx shows a nodular equal or slightly longer T1, T2 signal (A,B), surrounded by edema around the shadow. The lesion is connected to the wide base of the adjacent meninges. The adjacent cerebral convolution was an arc-shape under pressure. The foci are obviously enhanced after enhancement, and the adjacent meninges is thickened and enhanced (C-E). The irregular long T1, T2 signal shadow (F,G) indicates a point linear enhancement shadow and no edema signal shadow (H-J).
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F1
Additionally, the lesion was connected with the adjacent wide meningeal base, the adjacent cerebral convolution was accurate under the compression, and the adjacent lesions and meninges were thickened and enhanced after enhancement (Figures 1A-E). At re-examination after 6 months, the patient reported that symptoms such as headache and dizziness had disappeared; however, these symptoms were not relieved after the operation (Figures 1F-J).
The Warthin-Starry staining (magnification: x400) results indicated infiltration of plasma cells, lymphocytes and neutrophils, and a sleeve-like infiltration of lymphocytes around blood vessels, but did not identify Treponema pallidum
(A); The argyrophilic staining (magnification: x400) results indicated coagulation necrosis, infiltration of lymphocytes and plasma cells, and epithelial hyperplasia in small endangium, but did not identify Treponema pallidum
(B).
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F2
T. pallidum (Figure 2B). The 10-day post-surgery MRI indicated an annular high signal on the left frontal lobe and a nodular high signal at the anterior border.
PMC5835125_02
The Warthin-Starry staining (magnification: x400) results indicated infiltration of plasma cells, lymphocytes and neutrophils, and a sleeve-like infiltration of lymphocytes around blood vessels, but did not identify Treponema pallidum
(A); The argyrophilic staining (magnification: x400) results indicated coagulation necrosis, infiltration of lymphocytes and plasma cells, and epithelial hyperplasia in small endangium, but did not identify Treponema pallidum
(B).
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F2
T. pallidum (Figure 2B). The 10-day post-surgery MRI indicated an annular high signal on the left frontal lobe and a nodular high signal at the anterior border.
Enhanced MRI shows irregular masses lumped together mixed with high- and low-signal foci on the left frontal lobe. The border is less clear and is surrounded by a large low-signal shadow. The adjacent brain parenchyma is compressed, the lateral ventricle is compressed and deformed, and the central structure is slightly right-biased (A,B). At the follow-up 10 days after surgery, the left frontal lobe still presented with an annuliform high signal, the anterior border seemed to have a high nodular signal, and the lateral ventricle was still compressed and deformed (C,D).
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F3
The adjacent brain parenchyma and lateral ventricle were compressed and deformed, and the central structure was slightly right-biased (Figure 3). Additionally, the adjacent brain parenchyma and lateral ventricle were compressed and deformed, with the central structure slightly right-biased (Figures 3C,D).
HE staining of case 1 and case 2 showed that the center of syphilis was necrotic with infiltration of a large number of inflammatory cells and glial proliferation in the periphery (A,B); GFAP staining indicated a small amount of glial proliferation around necrotic foci (C,D), Ki67 staining showed a higher proliferative activity around the necrotic lesions (E,F), and P53 staining showed negative peripheral P53 (G,H).
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F4
HE staining of case1 and case 2 showed that the center of syphilis was necrotic with infiltration of a large number of inflammatory cells and glial proliferation in the periphery (Figures 4A,B); GFAP staining indicated a small amount of glial proliferation around netrotic foci (Figures 4C,D), Ki67 staining showed a higher proliferative activity around the necrotic lesions (Figures 4E,F), and P53 staining showed negative peripheral P53 (Figures 4G,H).
The bilateral frontal lobes showed a slightly longer and abnormal T1, T2 signal shadow with the lesion mainly on the left side (A,B). The enhanced lesion is located adjacent to the left interhemispheric cistern and is patchy-shaped and obviously enhanced, with the adjacent meninges being slightly thickened and enhanced (C-E). The follow-up after anti-syphilitic treatment indicated that the abnormal signal on the left frontal lobe was significantly absorbed in T1, T2 and enhanced scan (F-J).
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F5
After enhancement, the lesion adjacent to the left anterior interhemispheric cistern showed patchy enhancement, and the adjacent meninges were slightly thickened and enhanced (Figures 5A-E). TPPA were observed. The MRI re-examination showed that the abnormal signal of the left frontal lobe was significantly better than the previous images (Figures 5F-J).