case_images: PMC11652850_01
case_images: MRI images. (A-E) Axial T1WI, T2WI, T2-FLAIR, DWI, and ADC images, respectively; (F-H) Axial and sagittal contrast-enhanced scans. The images reveal nodular and mass-like lesions in the right fronto-parietal lobe, displaying hypointense T1 and slightly hyperintense T2 signals, with extensive peritumoral edema (yellow arrow). Contrast-enhanced images show significant enhancement, with cystic and necrotic areas visible within the lesion (blue arrow). There is a clear mass effect and infiltration of the adjacent dura mater (red arrow). On DWI, part of the lesion exhibits mild diffusion restriction (green arrow).
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case_images: MRI revealed significant heterogeneous enhancement of the lesion, with non-enhancing cystic and necrotic areas (Fig. 1). Magnetic resonance spectroscopy (MRS) demonstrated a markedly elevated Cho peak and decreased NAA peak in the right frontal lesion, with a Cho/NAA ratio of 26.57, NAA/Cr ratio of 0.18, and Cho/Cr ratio of 4.87 (Fig. 2).
case_images: Magnetic resonance spectroscopy (MRS). MRS shows a marked elevation of the Cho peak and a reduction in the NAA peak in the right frontal lesion. The Cho/NAA ratio is 26.57, the NAA/Cr ratio is 0.18, and the Cho/Cr ratio is 4.87, indicating neuronal cell damage.
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case_images: MRI revealed significant heterogeneous enhancement of the lesion, with non-enhancing cystic and necrotic areas (Fig. 1). Magnetic resonance spectroscopy (MRS) demonstrated a markedly elevated Cho peak and decreased NAA peak in the right frontal lesion, with a Cho/NAA ratio of 26.57, NAA/Cr ratio of 0.18, and Cho/Cr ratio of 4.87 (Fig. 2).
case_images: Pathological examination. (A) Tumor cells are diffusely arranged in sheets, exhibiting spindle or ovoid shapes with significant nuclear atypia, some with eosinophilic nucleoli, and frequent mitotic figures (HE, x 40); (B) Immunohistochemical staining: Tumor cells are focally positive for GFAP (x 20); (C) Immunohistochemical staining: Tumor cells are positive for Vim (x 20).
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case_images: The patient underwent surgical resection of the right fronto-parietal mass, and pathological examination confirmed the diagnosis of GS (WHO grade IV) (Fig. 3). The pathological diagnosis confirmed GS (WHO grade IV) (Fig. 3).