Fig. 2

Neuroimaging and pathological findings in the second hospitalization. Axial T1-WI shows a massive cystic lesion (a, red arrow) in the left temporal lobe with short T1 signals, and midbrain compression (a, yellow arrow). T2-WI shows long T2 signals (b, red arrow) in the cystic region with cerebral edema around the cyst (green arrow) and midline shift (b, yellow arrow). The signal intensity of the cystic focus region is low on diffusion WI (c, arrow) and high on the apparent diffusion coefficient (d, arrow) map. Flair imaging shows equal and even signals in the cystic region (e) and enhanced magnetic resonance imaging shows no enhancement of the cystic lesion (f). Postoperative pathological examination of the cystic wall indicates infiltrative growth of heteromorphic epithelial cells and inflammatory cell infiltration (g, hematoxylin & eosin stain, ×150). Immunohistological examination shows p40 protein (+), p63 protein (+), cytokeratin (+), Ki67 protein (approximately 40%, +); These findings are consistent with those of the metastasis of differentiated non-keratinizing nasopharyngeal carcinoma. Postoperative computed tomography shows the reduced cyst (red arrow) and midline deviation (h, yellow arrow). Flair: Fluid attenuated inversion recovery, WI: weighted image