case_images: PMC10991779_01
case_images: (A-E) preoperative imaging examination. Cranial MRI plain scan and enhanced (A), DWI (B), and CT (C) showed a space-occupying lesion in the skull at the right frontal-temporal-parietal roof (about 74.9*62.7*55.9mm) and showed hyperintensity on DWI, mixed with patchy hypointensity, fracture caused by tumor invasion of the skull (blue arrow), subfalcy herniation on the right side of the brain, mild obstructive hydrocephalus in the left lateral ventricle and the posterior lower part of the right lateral ventricle; In the anteroposterior and lateral positions of the right external carotid artery DSA (D), no tumor supply artery was seen; Cranial PWI (E) shows hypoperfusion of the tumor. (F), surgical process. (G, H), postoperative imaging examination. Cranial MRI plain scan and enhanced (G) and CT (H) showed mass lesion resection combined with skull enlargement resection. (I, J), postoperative pathological HE staining and immunohistochemistry, which reveals squamous epithelial cells covering the surface of the cystic wall, arranged in a star-like pattern, with a few wet keratinizations visible. No cellular atypia is observed, but there is minimal calcification in the stroma. I1-I3, HE x100, x200, x400, gradually enlarged images of the same field of view. J1, Ki67 x200, showing an approximately 20% increase in proliferation index; J2, P53 x200, showing wild-type expression. (K), scheduled craniotomy for repairing skull defects. MRI, Magnetic Resonance Imaging. DWI, Diffusion-Weighted Imaging; DSA, Digital Subtraction Angiography; PWI, Perfusion-Weighted Imaging; HE, Hematoxylin-Eosin.
case_images: fonc-14-1365625-g001.jpg
case_images: PMC10991779_01_fonc-14-1365625-g001.jpg
case_images: f1
case_images: An occupying lesion was observed in the right frontal-temporal-parietal region of the skull without supplying arteries on the Magnetic Resonance Imaging (MRI), Computed Tomography (CT), and Digital Subtraction Angiography (DSA) ( Figures 1A-E ). A subdural hematoma was observed after the dura mater was incised ( Figure 1F ). Postoperative follow-up imaging examinations showed tumor resection ( Figures 1G, H ). Pathological examination after surgery revealed an AM of the cranial bone ( Figures 1I, J ). Postoperative cranial CT showed that the skull reconstruction was good ( Figure 1K ), the head incision was well healed, there was no redness and swelling and exudation, and the sutures were removed and discharged.
case_images: (A) preoperative imaging examination. (B) postoperative imaging examination. (C) postoperative pathological HE staining. Microscopic examination revealed diffuse infiltration of nests and starry arrangement of squamous epithelial cells. The epithelial cells were arranged in patches and nests, with locally loose background. Pearl formation was observed between the nests of squamous epithelial cells. The tumor cells exhibited obvious pleomorphism and frequent nuclear divisions. The tumor infiltrated the dura mater and surrounding soft tissues, with focal necrosis. C1-C3, HE x100, x200, and x400 magnification of the same field, showing prominent nucleoli and significant cellular pleomorphism. C4, HE x400, demonstrating increased nuclear divisions in other fields. (D), postoperative immunohistochemical staining. D1, Ki67 x200, showing an approximately 60% increase in proliferative index. D2, P53 x200, showing wild-type expression. D3, Pan-CK x200, positive. D4, CK5/6 x200, positive. D5, P40 x200, positive. D6, beta-catenin x200, cytoplasmic positive. D7, BRAF V600E x200, negative. (E) pre-radiotherapy imaging examination. (F) imaging examination after the first phase. (G) imaging examination after the second phase. (H, I), follow-up radiological examination and images after 10 months. Blue arrows indicate the tumor. Red arrows indicate nuclear divisions. HE, Hematoxylin-Eosin.
case_images: fonc-14-1365625-g002.jpg
case_images: PMC10991779_01_fonc-14-1365625-g002.jpg
case_images: f2
case_images: On August 3, 2022, imaging examinations showed tumor recurrence on the outer edge of a previous repair site in the right frontal lobe with a hematoma surrounding the surgical site ( Figure 2A ). The patient underwent resection of the right frontal lesion on August 11, and postoperative imaging examinations confirmed removal of the recurrent tumor ( Figure 2B ). Postoperative pathological analysis revealed malignant transformation of the AM, characterized by noticeable cellular abnormalities and increased cellular proliferation following recurrence ( Figures 2C, D ). Follow-up imaging examinations revealed a nodular enhancing lesion at the anterior edge of the surgical area ( Figure 2E ). Subsequent follow-up imaging examinations revealed a progressive reduction in tumor size and fluid accumulation ( Figures 2F, G ). Follow-up imaging examinations demonstrated no evidence of tumor recurrence ( Figure 2H ) and metastasis. Examination revealed that the scalp incision overlying the original tumor in the frontal region had healed with the presence of a scab ( Figure 2I ).