Subsequent follow-up one year later, MRI showed a rounded marginal enhancing lesion in the left cerebellum now with hemorrhagic fluid level observed within the lesion. Surrounding perilesional edema is also observed with mild mass effect to the adjacent fourth ventricle. In addition, there is now a thick and defined enhancement in the region of the inferior cerebellum/occipital region with an irregular enhancement observed in the overlying soft tissue compartment (sagittal Gd and T2 images).
Subsequent suboccipital craniectomy was performed. Histopathologic examination now showed squamous cell carcinoma with brain and dural invasion, the cerebellar hematoma is likewise positive for tumor cells.