Unique Case Report of a Meningeal Sarcoma Arising during Ongoing Treatment for Progressing Intraparenchymal Glioma

Figure 2

The progression of astrocytoma and development of dural-based nodules. (a–d) Images of axial MRI: a mass in the right lateral to midtemporal lobe and associated area of hemorrhage at initial presentation (a), a growing nodule of contrast enhancement in the right frontal lobe at 5 months after completion of RT (b), follow-up 1 after 6 cycles of bevacizumab (c), and an increase in dural-based nodules involving the entire right hemisphere and the left cerebellum as well as an increase in size of the centrally necrotic mass in the right frontal lobe at follow-up 2 of dural-based nodules (d). White arrows indicate new dural-based nodular areas of enhancement. (e–h) Images of MRI perfusion: at initial presentation (e), at 5 months after completion of RT (f), at follow-up 1 after 6 cycles of bevacizumab (g), and at follow-up 2 of dural-based nodules (h). (i–k) Representative images of H&E staining: an initial Grade II Astrocytoma at high and low (inset) power (i), dural nodule showing increased mitotic activity at high and low (inset) power (k), and Grade III Astrocytoma at high and low (inset) power after second tumor resection (j).