case_images: PMC11045215_01
case_images: Timeline of the case.
case_images: cro-2024-0017-0001-538508_F01.jpg
case_images: PMC11045215_01_cro-2024-0017-0001-538508_F01.jpg
case_images: F1
case_images: A timeline of the patient's hospital course is illustrated in Figure 1.
case_images: Axial FLAIR (a) and T2WI (b) images show a heterogenous left occipital lobe cortical base intra-axial mass that is predominantly high on T2WI. c, d Radiotherapy plan for high-grade glioma, showing the dose to the what later became an STS. e, f Interval development of extracranial suboccipital mass demonstrates heterogeneous high-signal intensity on T2 and peripheral enhancement and nodularity on post-contrast T1WI. g, h Interval progression of the recurrent high-grade left occipital tumor on FLAIR and T2WI.
case_images: cro-2024-0017-0001-538508_F02.jpg
case_images: PMC11045215_01_cro-2024-0017-0001-538508_F02.jpg
case_images: F2
case_images: Brain magnetic resonance imaging (MRI) was performed, which revealed a heterogeneously enhancing mass in the left occipital lobe cortical base, measuring 2.8 x 2.5 x 2.2 cm in craniocaudal, anterior-posterior, and transverse diameters, respectively, with disproportionate vasogenic edema and mass effect (Fig. 2a, b). The patient received concurrent chemoradiotherapy with temozolomide and radiation therapy (60 Gy in 30 fractions using volumetric modulated arc therapy, Fig. 2c, d) to the surgical bed and surrounding brain tissue, as per standard radiation oncology protocols for high-grade gliomas, followed by adjuvant chemotherapy. T2 and peripheral enhancement and nodularity on post-contrast T1 (Fig. 2e, f). The patient underwent a re-excision of the lesion after the histopathology confirmed the neoplastic nature of the mass. MRI findings revealed an interval progression of the recurrent high-grade left occipital tumor (Fig. 2g, h).
case_images: a The first tumor is a hypercellular astrocytic neoplasm that exhibits hyperchromatic, pleomorphic, and irregular nuclei. The tumor cells show infiltration of the brain tissue with scattered foci of necrosis (arrows, H&E. x100). b This malignant glioma exhibits many gemistocytic cells with abundant eosinophilic cytoplasm (arrowheads) and easily detectable mitoses (arrow, H&E. x400). c GFAP immunohistochemical study highlights the tumor cells (GFAP, x400). d The Ki-67 proliferative index is increased in multiple tumor areas (Ki-67, x100). e The second tumor is a soft tissue neoplasm with cellular and hypocellular areas, abundant myxoid background, and areas of necrosis (arrows). The cells are pleomorphic and exhibit round-to-spindle, hyperchromatic, and atypical nuclei (H&E. x100). f A High-power view of the tumor shows a rich myxoid stroma and elongated curvilinear thin blood vessels and has easily detectable mitoses (H&E. x200). g GFAP immunohistochemical study is negative (GFAP, x100). h This tumor's Ki-67 proliferative index is markedly high (Ki-67, x100).
case_images: cro-2024-0017-0001-538508_F03.jpg
case_images: PMC11045215_01_cro-2024-0017-0001-538508_F03.jpg
case_images: F3
case_images: The pathology report revealed a high-grade glioma (Fig. 3a, b). Immunohistochemistry (IHC) for glial fibrillary acidic protein (Fig. 3c) was strongly positive in the tumor cells. The Ki-67 proliferative index was increased in multiple tumor foci (Fig. 3d). The immunohistochemistry studies showed that the tumor cells were negative for pan-CK (AE1/AE3), SMA, DESMIN, CD34, S100, synaptophysin, glial fibrillary acidic protein (Fig. 3g), and Neu-N. Ki-67 proliferation index was markedly high (~50%) (Fig. 3h).