PMC4496829_01
(a-e) MR images before the surgery demonstrating a tumor in the left parietal lobe. (a) The outer part of the tumor showed iso intensity, and the central part showed a low intensity area on T1-weighted imaging (T1WI). (b) The outer part of the tumor showed iso intensity, and the central part showed a high intensity area on T2-weighted imaging (T2WI). (c) The tumor had ring enhancement with gadolinium contrast medium on T1WI. (d) The central part of the tumor had a markedly high intensity area on diffusion-weighted imaging (DWI) (b = 1000 s/mm2). (e) On proton magnetic resonance spectroscopy, elevated lipid and lactate peaks were recognized. The choline peak was markedly elevated compared to the creatine peak. Cho: Choline. Cr: Creatine. (f) The tumor was confirmed to have been totally removed by postoperative MRI
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F1
The outer part of the tumor showed an iso intensity area on T1-weighted images (T1WI) and T2-weighted images (T2WI), while the central part showed a low intensity area on T1WI and a high intensity area on T2WI [Figure 1a and b]. The tumor was accompanied by wide perifocal edema on T2WI [Figure 1b]. It had ring enhancement with gadolinium contrast medium on T1WI [Figure 1c]. In addition, the central part of the tumor without gadolinium contrast enhancement exhibited a marked high intensity area on DWI (b = 1000 s/mm2) [Figure 1d], and the mean apparent diffusion coefficient (ADC) value of the central part was low (0.85/103 mm2/s). On proton magnetic resonance spectroscopy, elevated lipid and lactate peaks, but no abnormal signals for amino acids were identified [Figure 1e]. The tumor was totally removed on postoperative MRI [Figure 1f].
(a) Hematoxylin and eosin staining (x100). The tumor cells were predominantly arranged in sheets and small nests. The solid areas were composed of squamous epithelial (arrows), mucus-producing glandular (arrow heads) and intermediate cells. (b) PAS staining showed that the tumor had both necrotic (arrows) and solid mucin-positive areas (arrow heads) (x40). (c) PAS staining showed strong mucin positivity within the cytoplasm and intraluminal mucus (arrows) (x200). (d) Immunohistochemical staining of p40 showed nuclear positivity for the squamous cell component (x200)
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F2
The solid areas were composed of squamous epithelial, mucus-producing glandular and intermediate cells [Figure 2a]. Periodic acid schiff (PAS) staining revealed strong mucin positivity within the cytoplasm and intraluminal mucus [Figure 2b and c]. Immunohistochemical staining of p40 showed nuclear positivity for the squamous cell component [Figure 2d].