case_images: PMC5466962_01
case_images: Axial (A) and sagittal (B) T1 post-contrast and T2 fluid attenuated inversion recovery (C) images of the tumor at initial presentation.
case_images: fonc-07-00123-g001.jpg
case_images: PMC5466962_01_fonc-07-00123-g001.jpg
case_images: F1
case_images: MRI of the total spine showed no evidence of metastatic disease. MRI of the brain revealed a heterogeneously enhancing pineal mass measuring 2.3 cm x 2.5 cm x 2.3 cm (Figure 1).
case_images: Hematoxylin and eosin stains of the tumor, showing necrosis at 20x (A), mitotic figures at 40x (B), and microvascular proliferation at 40x (C).
case_images: fonc-07-00123-g002.jpg
case_images: PMC5466962_01_fonc-07-00123-g002.jpg
case_images: F2
case_images: The pathology revealed a high-grade glioma composed of markedly atypical cells, many with giant nuclei and containing abundant mitotic activity (seven mitoses in three high-powered fields), multiple foci of microvascular proliferation, and areas of pseudopalisading necrosis, consistent with GBM, World Health Organization Grade IV (Figure 2).
case_images: Axial and sagittal views of the dose distribution of the radiotherapy plan with the dose-volume histogram.
case_images: fonc-07-00123-g003.jpg
case_images: PMC5466962_01_fonc-07-00123-g003.jpg
case_images: F3
case_images: The combined radiotherapy plan is displayed in Figure 3.
case_images: Axial (A) and sagittal (B) T1 post-contrast and T2 fluid attenuated inversion recovery (C) images of the tumor at last follow up, 166 weeks following the initiation of chemoradiation.
case_images: fonc-07-00123-g004.jpg
case_images: PMC5466962_01_fonc-07-00123-g004.jpg
case_images: F4
case_images: The MRI performed 146 weeks after the initial biopsy, when compared over multiple prior studies dating back to 111 weeks post-biopsy, showed subtle, progressive increase in size of the pineal mass from 11 mm x 11 mm to 14 mm x 11 mm and a confluent periventricular white matter T2/fluid attenuated inversion recovery hyperintensity that is non-specific and stable, this was redemonstrated in his MRI at 166 weeks after biopsy (Figure 4).