case_images: PMC8571934_01
case_images: axial non-enhanced brain CT scan showing a left basifrontal tumor measuring 50 x 45 mm in diameter reaching the ipsilateral temporal lobe; this mass had a triple fleshy component (blue arrow), cystic (red arrows) and scattered foci of calcification (yellow arrows) in variable proportions; note the midline shift estimated at 6 mm without any uncal herniation
case_images: PAMJ-40-33-g001.jpg
case_images: PMC8571934_01_PAMJ-40-33-g001.jpg
case_images: F1
case_images: Diagnostic assessment: a non-enhanced brain CT scan (Figure 1) was performed immediately.
case_images: A) brain MRI in axial section showing a left basifrontal intra-axial lesion extended to the left polar temporal region, in hypointense on the T1-weighted sequences; B) in heterogeneous isosignal on the T2 sequences; C) not surrounded by an edematous reaction on FLAIR (fluid attenuated inversion recovery) sequence; D) enhancement after gadolinium injection is heterogeneous; E) note the heterogeneous hyper signal on the diffusion weighted images (DWI) without any hyperperfusion on perfusion sequences; F) cystic plaques and hypointense spots are seen on the gradient echo sequence; there was no intra-tumor bleeding on the susceptibility sequences
case_images: PAMJ-40-33-g002.jpg
case_images: PMC8571934_01_PAMJ-40-33-g002.jpg
case_images: F2
case_images: a thoraco-abdomino-pelvic CT scan in several coronal sections showing the absence of a primary lesion or any unusual enhancing mass
case_images: PAMJ-40-33-g003.jpg
case_images: PMC8571934_01_PAMJ-40-33-g003.jpg
case_images: F3
case_images: As part of the extension assessment, a thoraco-abdomino-pelvic computed tomography (CT) scan (Figure 3) was performed which failed to show any evidence of primary lesion or enhancing mass.
case_images: planar whole-body skeletal scan in anterior and posterior projections showing the absence of unusual increased 99mTc-MDP uptake in the whole skeleton; A) anterior and posterior blood pool whole body views; B) delayed anterior and posterior whole body bone scan
case_images: PAMJ-40-33-g004.jpg
case_images: PMC8571934_01_PAMJ-40-33-g004.jpg
case_images: F4
case_images: The whole body skeletal scintigraphy confirms the absence of any unusual increased tracer (technetium 99m-methyl diphosphonate: 99mTc-MDP) uptake in the whole skeleton (Figure 4).
case_images: axial non-enhanced postoperative CT scan showing a porencephalic cavity at the level of the tumor bed associated with pneumocephalus even subcutaneously; note the disappearance of midline shift and good decompression of healthy parenchyma
case_images: PAMJ-40-33-g005.jpg
case_images: PMC8571934_01_PAMJ-40-33-g005.jpg
case_images: F5
case_images: Postoperative CT scan at day 2 (Figure 5) showed a porencephalic cavity at the level of the tumor bed associated with pneumocephalus even subcutaneously and disappearance of the midline shift and good decompression of healthy parenchyma.
case_images: A) microscopic histopathological images showing a focal necrosis tumor proliferation, vaguely lobulated and crossed by fibrous septa (H & E 400x); this proliferation is of moderate cellularity made up essentially of small round monomorphic basophilic cells with a rounded or oval nucleus with a high nuclear/cytoplasmic ratio; focally, there was a transition between these undifferentiated embryonic cells with other neurocytically differentiated cells; the background of the proliferation is clearly fibrillary with presence of numerous Homer-Wright rosette images and pseudo-rosettes (H & E 400x); it is associated with micro calcifications and rare spumous histiocytes; B) microscopic immunohistochemistry (IHC) study showing that tumor cells were positive for INI-1, neurospecific enolase (NSE) (IHC for NSE 400x); C) synaptophysin (IHC for synaptophysin 400x)
case_images: PAMJ-40-33-g006.jpg
case_images: PMC8571934_01_PAMJ-40-33-g006.jpg
case_images: F6
case_images: Histopathological examination (Figure 6A) showed a focal necrosis tumor proliferation, vaguely lobulated and crossed by fibrovascular septa. Tumor cells were positive for INI-1, neurospecific enolase (NSE) (Figure 6B), Synaptophysin (Figure 6C), and CD 56 antibodies and were negative for epithelial membrane antigen (EMA), PS100, glial fibrillary acidic protein (GFAP), neurofilament and desmin.