PMC5569407_01
Pre-operative MRI of brain showing a solitary heterogeneously enhancing solid mass at the right temporal-parietal junction with surrounding edema, mass effect, and early uncal herniation (a and b). Immediate post-operative MRI of brain showing post-operative changes in right temporal-parietal area with gross total resection of the lesion (c and d). MRI of brain seven weeks after surgical resection showing no evidence of tumor progression, significantly improved edema around the resection area, and partially entrapped right occipital horn likely from intraventricular adhesive disease (e and f)
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F1
Magnetic resonance imaging (MRI) of her brain showed a solitary 4.6 cm x 3.4 cm x 4.1 cm heterogeneous solid mass at the right temporo-parietal junction with surrounding edema, mass effect, and early uncal herniation suggestive of either a metastasis or high-grade primary lesion [Figure 1a and b]. Postoperative MRI [Figure 1c and d] of her brain showed gross total resection of the lesion. The patient had a repeat MRI [Figure 1e and f] of her head in April 2016, which showed no evidence of tumor progression and significantly improved edema around the resection area.
Squamous cell carcinoma of the uterine cervix, metastatic to the brain: marked anaplasia and extensive keratinization of tumor cells. H and E x200 (a) and x400 (b). Note the sharp demarcation between tumor tissue and the surrounding compressed cerebral parenchyma. H and E, x400 (c). Immunohistochemical stains. Tumor cells are strongly positive for CK7 and CK5/6, x400 (d and e). In-situ hybridization for HPV (f)
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F2
The tumor cells displayed considerable anaplasia, and mitoses were numerous [Figure 2a and b]. There was a sharp demarcation between the tumor tissue and the surrounding compressed cerebral parenchyma, which showed gliosis and nerve fiber degeneration [Figure 2c]. Immunohistochemical stains revealed strong positivity for cytokeratin (CK) 7 and CK5/6 [Figure 2d and e], and also immunopositive for human papilloma virus (HPV), which was confirmed by in situ hybridization for HPV [Figure 2f].
Pre-operative MRI of brain, showing a new enhancing dural based lesion anterior to the prior resection cavity (a-d). Immediate post-operative MRI of brain, demonstrating gross total resection of the lesion (e and f)
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F3
An MRI showed a new single metastatic tumor measuring 2.3 x 3.5 cm2 noted in the right temporo-parietal area with significant surrounding edema within temporal lobe and extending into right parietal and occipital lobes [Figure 3a-d].