case_images: PMC11302587_01
case_images: Computed tomography without contrast (a) and T2-weighted magnetic resonance imaging (b) demonstrating large right frontoparietal intraparenchymal hematoma measuring 8.2 x 6.1 x 5.1 cm.
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case_images: PMC11302587_01_SNI-15-253-g001.jpg
case_images: F1
case_images: Computed tomography (CT) and magnetic resonance imaging (MRI) revealed right frontoparietal intracranial hemorrhage with mass effect requiring emergent decompressive craniectomy [Figure 1].
case_images: Axial computed tomography of the head (a) without contrast and (b) T2-weighted magnetic resonance imaging demonstrating large right frontoparietal intraparenchymal hematoma measuring 7.1 x 6.9 x 5.8 cm with evidence of edema.
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case_images: PMC11302587_01_SNI-15-253-g002.jpg
case_images: F2
case_images: Repeat imaging revealed an increased size of the right frontoparietal hematoma [Figure 2].
case_images: (a) Baseline cerebral angiogram showing parenchymal phase hypervascularity within fed primarily by a distal branch of the right pericallosal artery (parenchymal tumor blush); and (b) interventional radiology embolization with associated reduction in hypervascularity (red arrow).
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case_images: PMC11302587_01_SNI-15-253-g003.jpg
case_images: F3
case_images: An external ventriculostomy drain was placed, and neurointerventional radiology performed a transcatheter embolization of an abnormal distal anterior cerebral artery branch supplying an area of parenchymal phase hypervascularity using liquid embolic material [Figure 3].
case_images: (a) T1-weighted magnetic resonance imaging (MRI) demonstrating post-surgical changes with residual enhancing tumor along the margin of the surgical bed. (b) T1-weighted MRI showing residual tumor growth 2 weeks later. Heterogenous, multilobulated tumor now measuring 6.8 x 6.2 x 6.3 cm. (c) T1-weighted magnetic resonance imaging demonstrating diffuse leptomeningeal enhancement.
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case_images: PMC11302587_01_SNI-15-253-g004.jpg
case_images: F4
case_images: Immediate postoperative imaging showed a residual tumor centered at the left paramedian frontal lobe [Figure 4a]. In <3 weeks, the residual tumor grew significantly with associated hemorrhage and mass effect [Figure 4b]. The patient once again recovered, but then 2 months later presented with disease progression evidenced by extensive extra-axial metastatic lesions along the left cerebral convexity, basal cisterns, bilateral cerebellopontine angles, fourth ventricular outflow tract with leptomeningeal enhancement throughout the brainstem, and obstructive hydrocephalus [Figure 4c].
case_images: (a-c) Histological demonstration of resected tumor demonstrating a highly cellular (>80%), spindle celled, sarcomatous neoplasm with a fibrillary background, regional pseudopalisading necrosis, and pleomorphic changes including multinucleated, bizarre giant cells, and eosinophilic spheroids.
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case_images: PMC11302587_01_SNI-15-253-g005.jpg
case_images: F5
case_images: There were additional areas with pleomorphic changes, including multinucleated giant cells, eosinophilic spheroids, and regions with a fibrillary background [Figure 5].
case_images: (a and b) Histological demonstration of marked tumor vascularity with regional hemorrhage.
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case_images: PMC11302587_01_SNI-15-253-g006.jpg
case_images: F6
case_images: Marked tumor vascularity was noted with lakes of blood and necrosis, including those of vessel walls [Figure 6].