PMC5724986_01
A) Simple axial computed tomography showing a hemorrhage located in the left hemisphere from the semioval center to the middle frontal, pre-, and post-central gyri. B) Magnetic resonance imaging (MRI) T2 showing two lesions: 1) a heterogeneous lesion in the right superior and middle temporal gyri (red arrow); and 2) a hemorrhagic lesion with edema in the pre- and post-central gyri on the left side (blue arrow). C) MRI T2 gradient-echo showing a lesion located in the temporal lobe, with tubular forms lacking signal. D) MRI showing three vascular lesions (yellow, red, and blue arrows) with afferent vessels (arteries) and efferent vessels (veins).
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Magnetic resonance angiography (MRA) revealed three vascular lesions with afferent and efferent vessels (Fig. 1).
A) Posteroanterior view of cerebral angiography showed a tangle of serpiginous vessels inside the lesions; 1) one lesion was located in the temporal lobe which was supplied by the anterior and middle temporal artery of the middle cerebral artery; and 2) the second lesion was supplied by the angular artery. B) The late phase of the angiogram showed venous drainage in both lesions. C) Computed tomography (CT) showed a new hemorrhage in the lesion of the temporal lobe with an important mass effect, ventricular compression, severe cerebral edema, and midline deviation. D) Postoperative CT showed a decompressive craniectomy with a complete lesion resection.
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Cerebral angiography displayed two AV shunts (Fig. 2). CT scan showed a new hemorrhagic lesion in the temporal lobe, with severe cerebral edema (Fig. 2).
Round to polygonal cells with nuclear pleomorphism arranged in decohesive nests or irregular anastomosing cords. Note the presence of gland-like tubular structures and numerous blood vessels (arrowhead). Neoplastic cells showed immunoreactivity to SALL-4 (transcription factor). Histological and immunohistochemical findings were consistent with metastatic yolk sac tumor (H&E stain, original magnification = 100x).
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We termed this surgical technique the "angiometastasis technique." Histological and immunohistochemical analyses confirmed that the lesion was a NSGCT (yolk sac tumor) (Fig. 3).