case_images: PMC9449688_01
case_images: The patient's first cranial MRI results show that the brainstem is enlarged and swollen. (a) T1WI revealed a mass of abnormal low signal intensity in the brainstem near the fourth ventricle (arrow). (b) T1-FLAIR, (c) T2WI, (d) T2-FLAIR, and (e) DWI showed that the abnormal mass in the brainstem had high signal intensity (arrows). (f) There was no obvious enhancement of the abnormal signal. (g and h) Cho/NAA = 2.83, Cho/Cr = 3.75, NAA/Cr = 1.33 of MRS point of interest 2.
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case_images: The results of the cranial MRI (Figure 1) indicated that the patient had demyelinating lesions of the brainstem.
case_images: PET-CT (a) and 18F-FDG (b) did not reveal any obvious abnormalities.
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case_images: Because of the space occupying effect of the lesion, the possibility of neoplastic lesions (lymphoma) could not be excluded. 18F-FDG PET-CT revealed no obvious signs of tumor (Figure 2).
case_images: MRI performed after 4 weeks. (a) T1WI revealed that the further enlargement of abnormal low signal intensity (arrow). (b) T1-FLAIR, (c) T2WI, and (d) T2-FLAIR revealed that the further enlargement of abnormal high signal intensity in the brainstem and the compression on the surrounding brain tissue was more obvious (arrows). (e and f) Cho/NAA = 7.93, Cho/Cr = 4.88, NAA/Cr = 1.21 of MRS point of interest 3.
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case_images: Four weeks later, a head MRI scan (Figure 3) revealed a high-grade astrocytoma which differed from a lymphoma.
case_images: Figure showing the pathological picture of the lesion after the operation. (a) Hematoxylin and eosin staining of this lesion shows high local cell density, a rich nest cytoplasm, large cell body, multinucleated giant cells, and degenerative cells (arrows). (b and c): Immunohistochemical staining shows that the tumor cells are positive for GFAP (b) and p53 (c). (d) The Ki-67 labeling index is approximately 50%.
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case_images: The final histopathology findings were consistent with an AA (WHO grade III) (Figure 4).