case_images: PMC11067332_01
case_images: T1-Weighted sagittal (A) and axial (B) MRI images show a large mass occupying majority of the left cerebellar hemisphere. Small focal areas of necrosis are seen within the superior and lateral aspect of the mass. Some contrast enhancement of the margin of the mass is seen, however, the majority of the mass within the centre of the lesion does not show any significant enhancement. There is an inferior descent of the cerebellar tonsils with obliteration of the CSF spaces at the craniocervical junction.
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case_images: PMC11067332_01_gr1.jpg
case_images: fig1
case_images: MRI of the brain (Fig. 1) and spine was performed, which did not demonstrate disseminated disease.
case_images: (A) Low power view showing diffuse infiltration into cerebellar folia. The folium on the left is preserved, some residual structures remain in the folium in the middle whilst the architecture of the folium on the right is completed effaced. (B) Immunohistochemistry to synaptophysin highlights the respective preservation, partial loss and effacement of cerebellar structure seen in A. The preserved folium on the left shows a normal pattern with synaptophysin labelling synaptic structures in the molecular (outer) layer and granule cell layer. (C) The tumour has the architecture of a typical diffuse astrocytoma. Note numerous dilated vessels, focally showing true microvascular proliferation (arrow) and thrombosis (open arrow). (D) Necrosis is present at the edge of the tumour fragment. (E) Tumour cells in this area have small pleomorphic nuclei with delicate fibrillary processes in a myxoid background. Two mitoses (arrows) are present in this field. (F) Immunohistochemistry for GFAP (brown signal) labels only a proportion of tumour cells. (G) Immunohistochemistry to neurofilament protein labels residual axons in infiltrated tissue. (H) The tumour shows a very brisk Ki67 labelling index. (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)
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case_images: PMC11067332_01_gr2.jpg
case_images: fig2
case_images: Histological examination revealed an astroglial tumour of moderate-to-high cellularity with a diffusely infiltrative pattern (Fig. 2).
case_images: T1-Weighted sagittal (A) and axial (B) images performed in May 2023 (10 years postoperatively), which were reported as showing stable intracranial appearances without evidence of abnormal enhancement.
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case_images: PMC11067332_01_gr3.jpg
case_images: fig3
case_images: The most recent imaging was performed in May 2023 (Fig. 3).