PMC9685797_01
A representative image of the head CT scan shows the irregular bone structure with mixed density mass on the left side of the cranial plate in the median frontal area, slightly reduced density in the bilateral parietal lobes, widening of the ventricles and extracerebral space, and thickening of the septal sinus mucosa. (A) Sagittal view shows a mass in the frontal area. (B,C) Soft tissue window at the central level of the lateral ventricle show a high-density mass in the left frontal region. (D) Bone window at the central level of the lateral ventricle: the bony structure of the left cranial plate in the middle frontal region is irregular, and there is a mixed density mass shadow.
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F1
A representative image of the cardiac ultrasound (postoperative) shows the normal internal diameter of each chamber, low septal motion amplitude, and strong plaque echoes around the septum. The right ventricular outflow tract is not obstructed. The muscle bundles are not hypertrophic. The internal diameter of the pulmonary artery was normal.
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F2
The postoperative cardiac ultrasound (Figure 2) showed that the inner diameter of the cardiac cavities was within the normal range. The inner diameter of the pulmonary artery was normal (Figure 2). The peak forward flow velocity of the pulmonary artery flow was 2.2 m/s (Figure 2).
Representative image (x 100) shows the histopathological analysis of the tumor tissue. The tumor tissue consists mainly of neuroblastoma-like cells and melanin-containing epithelial cells. (Left) The small round or square and primitive neuroblastoma-like cells are large and contain melanin granules in the cytoplasm of the epithelial cells. The deep-stained and shrunken neuroblastoma-like cells are mostly arranged in nests with extruded nuclei. (Right) Pigmented epithelioid cells with vacuolated nuclei are observed in the large area surrounding the neuroblastoma-like cells. Some areas are mainly composed of pigmented epithelioid cells arranged in sheets, nests, or beam bundles, with dense fibrous connective tissue between the nests of cells, and some areas can be seen as bone trabeculae with visible nuclear schizograms (0-2 per 10 high magnification fields).
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F3
Under the postoperative pathological microscope (Figure 3), most of the lesion tissue was hyperplastic and fibrous with abundant new bone trabeculae.
Representative immunohistochemical staining images (x 200) (from left to right) of the MNT1 tumor sections for cytokeratin (CK, epithelioid +), S-100 protein (epithelioid +), melanoma antibody (HMB45, epithelioid +), neuron-specific dilute alcoholase (NSE, small round cell +), synaptophysin (Syn, small round cell +), and Ki67. Nearly, 15% of the nuclei were Ki-67 positive.
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F4
Immunohistochemistry of the lesion showed cytokeratin (CK)-positive epithelial cells, synaptophysin (syn)-positive small blue cells, S-100-positive, HMB45-positive, CD99-negative, CD3-negative, NSE-positive, ERG-positive vascular endothelium, and 15% Ki67-positivity (Figure 4).
Timeline of the patient's clinical journey.
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F5
The timeline of the patient's clinical journey is shown in Figure 5.