A right temporal-occipital lobe Grade III anaplastic PXA in a 23-year-old female with a predominantly solid mass and cystic changes. (A) Axial T1WI showing the iso-intense of the solid component. The lesion was closely associated with the lateral ventricle and even invasion of the temporal horn of the lateral ventricle. (B) Contrast-enhanced sagittal T1WI showing marked enhancement of the solid component. (C) DWI showing restricted diffusion of the solid component. (D) The mean ADC of the mural nodule was 0.75 × 10−3 mm2/s, and the mean ADC ratio was 0.92. (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 not detected.