case_images: PMC11152550_01
case_images: Initial computed tomographic reveals left inferior frontal mass measuring 3.7 x 3.3 x 2.8 cm.
case_images: SNI-15-162-g001.jpg
case_images: PMC11152550_01_SNI-15-162-g001.jpg
case_images: F1
case_images: Initial computed tomographic (CT) imaging revealed a left inferior frontal mass concerning primary CNS neoplasm [Figure 1].
case_images: Follow-up magnetic resonance imaging demonstrating a cystic and solid mass lesion in the left inferior frontal gyrus associated with a cluster of enhancing microcystic lesions as well as a thick rim of restricted diffusion most conspicuous along the inferior medial aspect.
case_images: SNI-15-162-g002.jpg
case_images: PMC11152550_01_SNI-15-162-g002.jpg
case_images: F2
case_images: The following day, MRI confirmed the above findings as a cystic and solid mass lesion in the left inferior frontal gyrus associated with a cluster of enhancing microcystic lesions as well as a thick rim of restricted diffusion most conspicuous along the inferior medial aspect [Figure 2].
case_images: Postoperative magnetic resonance imaging the day following surgery demonstrating expective interval operative changes.
case_images: SNI-15-162-g003.jpg
case_images: PMC11152550_01_SNI-15-162-g003.jpg
case_images: F3
case_images: Postoperative imaging the following day demonstrated expected interval changes related to the tumor resection and apparent residual enhancing tumor at the deep posterior margin in close proximation to the hypothalamus, anterior commissure, and anterior left optic tract [Figure 3].
case_images: 6-week postoperative magnetic resonance imaging demonstrating an ill-defined enhancement in the left subcallosal region at the deep posterior margin of the resection cavity consistent with a residual tumor.
case_images: SNI-15-162-g004.jpg
case_images: PMC11152550_01_SNI-15-162-g004.jpg
case_images: F4
case_images: A 6-week postoperative MRI demonstrated postsurgical changes related to the left frontal mass resection and ill-defined enhancement in the left subcallosal region at the deep posterior margin of the resection cavity consistent with residual tumor [Figure 4].
case_images: (a) Section shows the proliferation of small oval to round primitive neuronal cells with hyperchromatic, polygonal nuclei. The tumor shows scant mitotic activity (arrows highlight mitotic figures). (b and c) Tumor cells exhibit diffuse, strong immunoreactivity to OLIG2 and synaptophysin. (d) Tumor cells show moderate Ki-67 proliferation (8-10%). (e and f) Tumor cells exhibit negative immunoreactivity to Vimentin and glial fibrillary acidic protein (GFAP).
case_images: SNI-15-162-g005.jpg
case_images: PMC11152550_01_SNI-15-162-g005.jpg
case_images: F5
case_images: Complete pathology results confirmed a final diagnosis of CNS neuroblastoma, FOXR2 activated, and CNS WHO grade 4 [Figure 5].