PMC5191621_01
Images before the first operation.. Notes: (A and B) Brain computed tomography showed a supra/retrosellar germinoma (black arrow). (C) Brain magnetic resonance imaging T2-weighted image showed an intrasellar and suprasellar lobulated cystic germinoma with retrosellar extensions; optic chiasm and retrochiasmatic optic tract (optic chiasm indicated by white horizontal arrow) are mainly affected. No hydrocephalus. White short arrow indicates pineal germinoma. R indicates right side and L indicates left side.
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Brain computed tomography (CT) and brain magnetic resonance imaging (MRI) showed intrasellar/suprasellar lobulated cystic mass and associated optic chiasm/retrochiasmatic optic tract, and a pineal gland mass (Figure 1).
Follow-up magnetic resonance imaging after the first operation.. Notes: Some parenchymal hemorrhage (black arrows) and edema were seen over the right frontal lobe along the surgical route. A subacute subdural hematoma (white arrow) was seen over the right frontal region. White arrowhead indicates a small pineal germinoma.
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His headache, dizziness, and atypical MDE symptoms subsided only after receiving microsurgery and radiosurgery (Figure 2), and the histopathology report showed intrasellar, suprasellar, and pineal germinoma.
Follow-up images ~7 months after the first operation.. Notes: (A) Axial view of T2-FLAIR image of MRI. (B) Coronal view of T2-FrFSE image of MRI. (C) Diffusion-weighted imaging of MRI. (A-C) Indicate the recurrence/regrowth of residual germinoma involving optic chiasm (A, B: circle), hypothalamus (C: black arrow). Mild dilated ventricles were noted (C: white arrowhead). (D) T1 weighted image of MRI: the intra/suprasellar germinoma was more superiorly extended involving foramen of Monro (black arrow) and nearby genu of corpus callosum (double-headed arrow). No significant interval change of pineal gland germinoma (white arrow) compared to (C). Mild hydrocephalus (white arrowhead).. Abbreviations: MRI, magnetic resonance imaging; T2-FLAIR, T2-weighted fluid-attenuated inversion recovery; T2-FrFSE, T2-weighted fast recovery fast spin echo.
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BW gain of 5.7 kg. Brain MRI showed local recurrence of residual tumor at optic chiasm and hypothalamus and obstructive hydrocephalus (Figure 3).
Follow-up brain computed tomography after the second operation.. Notes: Focal brain tissue damage in the right frontal lobe (white arrow). R indicates right side and L indicates left side.
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The patient's depressive mood, increased appetite, and hunger partially improved after receiving ventriculoperitoneal shunting, radiosurgery, and diet restriction (Figure 4).