case_images: PMC4494585_01
case_images: MR images showing solitary intrinsic lesion centred around the pre-central gyrus, confirmed to be metastatic deposit of MPM on histological assessment.. A/B: Post-gadolinium T1-weighted images; C: T2-weighted image
case_images: cureus-0007-000000000241-i01.jpg
case_images: PMC4494585_01_cureus-0007-000000000241-i01.jpg
case_images: FIG1
case_images: CT and magnetic resonance (MR) imaging revealed a heterogeneously enhancing intrinsic lesion centred around the right pre-central gyrus measuring 22 mm x 30 mm x 20 mm with extensive surrounding oedema (Figure 1), highly suspicious of a solitary metastasis.
case_images: Postoperative MR images confirming gross total resection.. A/B: Post-gadolinium T1-weighted images showing some hyperintense material in the cavity that does not enhance compared to pre-contrast sequence; C: T2-weighted image
case_images: cureus-0007-000000000241-i02.jpg
case_images: PMC4494585_01_cureus-0007-000000000241-i02.jpg
case_images: FIG2
case_images: He underwent gross total resection, confirmed on postoperative MR imaging (Figure 2).
case_images: Histological images confirming diagnosis of MPM. . A: light microscopy with haematoxylin & eosin stain showing a malignant neoplasm featuring sheets of cohesive epithelioid and plump spindle cells with large nuclei, lobulated nuclear outlines and prominent nucleoli. There were multiple foci of tumour necrosis and conspicuous mitotic activity. No glandular or squamous differentiation was identified. B/C: Immunohistochemical preparations showing diffuse and strong positivity for broad-spectrum cytokeratin AE1/3 (B) and patchy but strong staining for calretinin (C). There was also patchy but strong staining for cytokeratin 5/6 and epithelial membrane antigen with only weak focal staining for D2-40.
case_images: cureus-0007-000000000241-i03.jpg
case_images: PMC4494585_01_cureus-0007-000000000241-i03.jpg
case_images: FIG3
case_images: Light microscopy and immunohistochemistry of the excised lesion confirmed the suspected diagnosis of metastatic mesothelioma (Figure 3).