Article Figures & Data
Figures
- FIG 1.
MR images and tumor characterization on multiple sequences. A, Axial T2 image shows the right frontal solid-cystic mass, with large peripheral cysts (long arrow) and an eccentric bubbly-appearing solid component (short arrow). B, Axial FLAIR demonstrates that the signal intensity of the content of the peripheral cyst is not suppressed (asterisk), as well as mild perilesional edema (arrow). C, ADC map shows foci of intensely restricted diffusion on the anterior and solid aspect of the lesion (arrow). D, Axial SWI demonstrates foci of marked hypointensity (arrows), corresponding to punctate calcifications according to the filtered phase signal (not shown). E, Axial T1 image demonstrates an isointense to gray matter heterogeneous solid portion (short arrow) with a hypointense large peripheral cyst (long arrow). F, Axial T1 postgadolinium image shows intense heterogeneous enhancement of the solid part, with multiple small permeating cysts, giving the tumor a bubbly aspect (short arrow). The large peripheral cysts show no enhancement (long arrow).
- FIG 2.
Advanced MR imaging features. A and B, Axial relative CBV map and curves, respectively, show intensely increased perfusion (1.8×) within the solid part of the tumor, raising suspicion for a high-grade lesion. C and D, T1 perfusion Ktrans map and curves, respectively, demonstrate intensely increased permeability and Ktrans values in the enhancing portion of the lesion (0.170), suggesting increased capillary permeability. E, Proton spectroscopy shows an increased Cho peak, with increased Cho/Cr and Cho/NAA ratios, inferring cellular proliferation, as well as an increased lipid-lactate peak, suggesting anaerobiosis. LL indicates lipid lactate; USR1/2, Muon spin rotation; N-ace, N-acetylaspartate; MI, myoinositol.
- FIG 3.
Intraoperative surgical microscope images. A, External view of the tumor demonstrates its peripheral cystic areas (arrow). B, Solid portion of the lesion after the cyst evacuation (arrow). C, The solid aspect of the tumor under blue light demonstrates its intense 5-ALA fluorescence (arrow).
- FIG 4.
The schematic representation of astroblastoma consists of a hemispheric heterogeneous lesion with a lobulated solid and eccentric component and peripheral larger cysts. Note the faint perilesional edema, disproportional to the size of the lesion.
- FIG 5.
Pathologic findings of astroblastoma. A, The lesion was composed of solid sheets and pseudopapillae, with prominent hyalinized vessels (arrows), H&E, original magnification ×100. B, Tumor cells have well-defined cytoplasmic borders, a columnar aspect radially arranged around the hyalinized blood vessels, forming astroblastic pseudorosettes (arrow), H&E, original magnification ×100. C, Tumor shows rhabdoid features consisting of large cells with abundant eosinophilic cytoplasm and eccentric nuclei, H&E, original magnification ×100. Tumor cells are diffusely positive for GFAP (D, immunohistochemistry, original magnification ×100) and D2-40 (E, immunohistochemistry, original magnification ×200).
