case_images: PMC11196406_01
case_images: Magnetic resonance imaging findings during the patients' treatment. (A) Axial post-enhancement T1 weighted images showing a right-sided contrast lesion in the parietal and basal ganglia area, measuring 5.1*4.2*3.7 cm3, and a right frontal lobe cystic mass. (B) Axial post-enhancement T2 weighted Propeller images to avoid artifacts. (C) Heterogenous, T1 weighted isometric lesion in the basal ganglia area, with midline shift and sub-calcaneal hernia. (D) Axial T1-FLAIR-weighted images showing parietal lesions as heterogeneous lesions with high contrast frontal cystic masses. Diffusion tensor imaging (E) showing the cerebral neurofibril trajectory and factional anisotropy (F). (G) Preoperative sagittal T1-weighted images reveal two heterogeneous lesions with peripheral edema zone. (H) Postoperative sagittal T1-weighted images showing sub-total tumor resection with partial contrast (to avoid neurological deficits).
case_images: fonc-14-1308497-g001.jpg
case_images: PMC11196406_01_fonc-14-1308497-g001.jpg
case_images: f1
case_images: T1-weighted images (T1WIs) and T2WIs and contrast enhancement with peri-lesion edema and midline shift, size approximately 5.1*4.2*3.7 cm3 ( Figures 1A, B ). The other lesion was a saccular mass located in the right frontal lobe ( Figures 1C ). Several nodular, clustered bands of edema with hyperintensity on fluid-attenuated inversion recovery (FLAIR) images and diffusion-weighted imaging (DWI) were seen ( Figures 1D-G ). Postoperatively, the patient's left-sided muscle strength recovered from grade II to grade IV, and MRI revealed minimal contrast enhancement of residual lesions ( Figure 1H ). PCRR-Fluorescent with QIAamp FFPE Tissue Kit confirmed the presence of IDH1 R132 mutation and revealed no TERT promoter mutations ( Table 1 ,  Supplementary Figure S1 ).
case_images: Histological and fluorescence in situ hybridization (FISH) examinations. (A) Diffuse infiltrating growth of tumor cells seen microscopically. (B) Tumor cells of variable size, with coarse chromatin, nucleoli, and nuclear fission. Dense growth of tumorigenic astrocyte-like cells in the Virchow-Robin interstitial. (C) FISH assay revealing the EGFR amplification. The red arrow represents the gene EGFR, a total of 207; The green arrow denotes the GSP-17 chromosome, a total of 75. (D) FISH assay suggesting CDKN2A/B nonpure deletion. Green arrow (G) for/CSP9, red arrow (R) for CDKN2A. (E) Tumor cells are infiltrated in sheets of nests, cells are ovoid/short pike with mild cell morphology. (F) Lower cell density and microcyst formation in the frontal area.
case_images: fonc-14-1308497-g002.jpg
case_images: PMC11196406_01_fonc-14-1308497-g002.jpg
case_images: f2
case_images: Microscopically, the cells were dense, tightly arranged, and of variable size, coarse chromatin, visible nucleoli, and nuclear schizophrenia was atypical ( Figures 2A, B ). Detection of CDKN2A/B by fluorescence in situ hybridization (FISH) suggested non-purifying deletions ( Figures 2C, D ). Pathological diagnosis of the frontal lesion was a WHO grade II IDH-NOS (Isocitrate Dehydrogenase-Not otherwise specified) diffuse astrocytoma without necrosis and microvascular proliferation ( Figures 2E, F ). The cells were positive for p53, and ATRX staining was not observed ( Supplementary Figure S2 ).