case_images: PMC3230756_01
case_images: The diffusely swollen mesencephalon, uncus and parahippocampal gyrus on FLAIR (A) and T2 MRI-sequences (B), as well as the absence of gadolinium enhancement (C and E) is compatible with the radiological criteria for gliomatosis cerebri. There is diffuse enlargement of the pons (D)
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case_images: PMC3230756_01_11060_2011_678_Fig1_HTML.jpg
case_images: Fig1
case_images: These radiological characteristics were compatible with gliomatosis cerebri (Fig. 1). 
case_images: A needle biopsy was taken from tumor in the right mesiotemporal region (green tract)
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case_images: PMC3230756_01_11060_2011_678_Fig2_HTML.jpg
case_images: Fig2
case_images: To establish a histopathological diagnosis, she had a frameless stereotactic needle biopsy of the right mesiotemporal region with a Sedan side cutting needle through a regular burrhole (Fig. 2).
case_images: Initial brain biopsy. The left hand panel shows hematoxilin-eosin-stained section of cortical tissue with slight increase in cellularity (objective x2.5). The cells are somewhat irregular, as is better appreciated in the right hand panel, a GFAP staining for astrocytic cells (objective x40), showing clear atypia of the positive-staining cells. Given the relative paucity of these cells and their diffuse spread throughout the biopsy a histopathological diagnosis of gliomatosis was made
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case_images: PMC3230756_01_11060_2011_678_Fig3_HTML.jpg
case_images: Fig3
case_images: GFAP positive staining cells (Fig. 3). Given the relative paucity of these cells and their diffuse spread throughout the biopsy, a diagnosis of gliomatosis of the astrocytic subtype (WHO grade 2) was made.
case_images: The subcutaneous lesion (blue arrow), in the biopsy tract is not continuous with the intracranial compartment. The hyperdensity in the pons is thought to be a tumor related bleeding, which was probably not biopsy related
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case_images: PMC3230756_01_11060_2011_678_Fig4_HTML.jpg
case_images: Fig4
case_images: However, three months later, the headaches progressed, accompanied by a subcutaneous swelling at the incision, due to which the patient was unable to wear her glasses (Fig. 4).
case_images: Resection specimen of skin and subcutaneous tissues. The inset in the top left hand corner shows a low-power view, showing epidermis and dermis. In the larger figure, the image is dominated by oligodendrocytes with a clear cytoplasm and slightly irregular nuclei; in addition, there is a component of large, multinucleated astrocytic cells, warranting the diagnosis of oligoastrocytoma in this specimen. Both figures are hematoxilin-eosin stained. (The inset is a x1.25 objective, the large figure a x40 objective)
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case_images: PMC3230756_01_11060_2011_678_Fig5_HTML.jpg
case_images: Fig5