case_images: PMC4960923_01
case_images: Magnetic resonance imaging of the head without contrast (a) and with contrast was performed (b), which showed a posterior fossa mass that enhanced inhomogenously, as well as noncommunicating hydrocephalus
case_images: SNI-7-481-g001.jpg
case_images: PMC4960923_01_SNI-7-481-g001.jpg
case_images: F1
case_images: T1-weighted images, an inhomogenously enhanced appearance in T1-weighted contrast images, and iso-hyperintensity in T2-weighted images. The MRI also revealed that the temporal horns were more than 2 mm with frontal horns-internal diameter ratio (FH/ID) of 50% and the Evan ratio of 0.3. [Figure 1a and b] Preoperative investigation suggested that the patient had an infratentorial mass at the fourth ventricle, suspected ependymoma, which caused a noncommunicating hydrocephalus.
case_images: The tumor had been treated with prone position (a), skin incision line (b), surgical view (c) and gross-total surgical excision (d) Craniotomy Tumor Removal Transvermian
case_images: SNI-7-481-g002.jpg
case_images: PMC4960923_01_SNI-7-481-g002.jpg
case_images: F2
case_images: We performed ventriculoperitoneal shunt procedure to overcome the hydrocephalus and transvermian craniotomy tumor removal to eradicate the tumor [Figure 2a-d].
case_images: Histological examination, magnification 100x (a) and 200x (b) shows carrot-shaped cell with polimorfic hyperchromatic nuclei and Homer Wright Rossetes appearance as patognomonic sign for medulloblastoma
case_images: SNI-7-481-g003.jpg
case_images: PMC4960923_01_SNI-7-481-g003.jpg
case_images: F3
case_images: A histopathology sample from the mass was obtained and the examination revealed a "carrot-shaped cell" with polymorphic hyperchromatic nuclei and "Homer Wright Rosettes" appearance, which suggested that the mass was medulloblastoma [Figure 3a and b].
case_images: Immunohistochemistry analysis was conducted and the result showed that the tumor is positive for glial fibrillary acidic protein, synaptophysin, and smooth muscle actin (a-c), whereas negative for cytokeratin, desmin, and epithelial membrane antigen (d, from upper, middle, and lower figures, respectively)
case_images: SNI-7-481-g004.jpg
case_images: PMC4960923_01_SNI-7-481-g004.jpg
case_images: F4
case_images: In addition, immunohistochemical analysis was also conducted and the result showed that the tumor was positive for glial fibrillary acidic protein (GFAP), synaptophysin, and smooth muscle actin [Figure 4a-c], whereas it was negative for cytokeratin, desmin, and epithelial membrane antigen (EMA) [Figure 4d].