PMC4442262_01
(a) Preoperative computed tomography (CT) showing calcified tumor in the interhemispheric fissure. (b, c) Preoperative magnetic resonance imaging (MRI) showing a lesion along the corpus callosum, appearing hyperintense on T1-weighted imaging (b) and isointense on T2-weighted imaging (c) associated with expanding perifocal edema. (d, e) The mass shows heterogeneous enhancement with gadolinium or axial (d) and sagittal images (e).
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A calcified cystic lesion was noted in the corpus callosum on computed tomography (CT) (Figure 1(a)). Magnetic resonance imaging (MRI) showed a lesion with two components appearing hyper- and isointense on T1- and T2-weighted imaging with heterogeneous gadolinium enhancement (Figures 1(b)-1(e)).
Schema of intraoperative findings. (a) Incision of the initially yellowish tumor (lipoma component) results in projectile bleeding. (b) The grayish tumor is exposed just behind the A3. Residual lipoma is observed posteriorly.
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The mass was located extra-axially and was not attached to the falx (Figure 2), consisting of two components corresponding to the MRI findings (Figures 2(a) and 2(b)).
(a) Histological findings reveal mature adipose tissue with a small amount of collagen and thickened blood vessels from the yellowish tumor. (b, c) Greyish tumor shows marked calcification in most parts (b) and spindle-shaped cells in the sheet (c). Infiltration of mononuclear inflammatory cells along with immature cells showing hyperchromatic nuclei. Hematoxylin and eosin: (a-c) x100; (d) x400.
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The yellowish tumor consisted of mature adipose tissue containing a small amount of collagen and thickened blood vessels (Figure 3(a)). Several small specimens from the grayish tumor displayed marked calcification in most parts (Figure 3(b)). Infiltration of mononuclear inflammatory cells was identified, along with proliferation of small vessels (Figure 3(c)). Immature cells with hyperchromatic nuclei were also present (Figure 3(d)).
(a) Immunohistochemical findings showing strong positive staining for neurofilament (NF) in calcified areas. (b) Small foci in calcified areas are positive for S-100. (c) In noncalcified areas, spindle cells are positive for alpha-smooth muscle actin (SMA). (d) Immature cells with hyperchromatic nuclei along with infiltrating mononuclear inflammatory cells are weakly positive for vimentin. Hematoxylin and eosin: (a) x400; (b) x200; (c) x200; (d) x400.
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The calcified areas displayed selective, strong immunostaining for neurofilaments (NFs) (Figure 4(a)). Occasionally, fiber-like linear staining of NFs arranged in parallel was seen, and small, S-100-positive foci were found in the calcified areas (Figure 4(b)). In noncalcified areas of the specimens, spindle cells immunopositive for alpha-smooth muscle actin (SMA) were seen intersecting fascicles with deposition of collagen fibers (Figure 4(c)). Immature cells with hyperchromatic nuclei showed weak immunostaining for vimentin (Figure 4(d)).