A right parietal-occipital lobe Grade III anaplastic PXA in a 46-year-old male with a predominantly cystic mass and a mural nodule close to the meningeal side. (A) Axial T2WI showing the iso-intense mural nodule and the homogeneously hyper-intense cystic component. (B) Contrast-enhanced axial T1WI showing marked enhancement of the mural nodule and cystic wall. (C) DWI showing restricted diffusion of the mural nodule. (D) The mean ADC of the mural nodule was 0.87 × 10−3 mm2/s, and the mean ADC ratio was 1.08. (E) Photomicrography of the tumor showing marked cellular pleomorphism, with spindle cells, multi-nucleated giant cells with bizarre nuclei, and lipid-filled xanthomatous cells. Significant mitotic activity was present (H&E, ×400). (F) Molecular detection showing the BRAFV600E mutation.