PMC8602065_01
Radiological evaluation of yolk sac tumor before operation. A noncontrast CT scan showed a slightly hyperdense mass located in the left cerebellar hemisphere (A). The tumor was slightly hypointense on axial T1-WI (B) and slightly hyperintense on axial T2-WI, FLAIR and DWI (D, E). Postcontrast (gadolinium-enhanced) axial, coronal and sagittal MRI showed prominent homogeneous enhancement (F-H). The fourth ventricle was compressed and narrowed. Mild edema was noted around the lesion. (B-H). WI, weighted imaging.
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Before operation, brain noncontrast computed tomography (CT) showed an irregular oval tumor of slight hyperdensity in the left cerebellar hemisphere ( Figure 1A ). The tumor showed slight hypointensity on axial T1-WI ( Figure 1B ) and slightly high signal intensity on axial T2-WI, FLAIR and DWI ( Figures 1C - E ). Postcontrast enhancement on axial, coronal and sagittal MRI indicated prominent homogeneous enhancement ( Figures 1F - H ). Mild edema was noted around the lesion. ( Figures 1B - H ).
The operative findings and histopathology. (A) The tumor was located in the left cerebellar hemisphere and measured 4.5 cmx 4 cm. (B, C) Photomicrograph of hematoxylin and eosin staining showed that malignant tumor cells grew around the blood vessels or cavity, with typical Schiller-Duval bodies (red arrow). (D) Photomicrograph of immunohistochemical staining revealed that the majority of the tumor cells were strongly positive for alpha-fetoprotein (AFP) in the cytoplasm. (E) Photomicrograph of immunohistochemical staining suggested a positive reaction for Sal-like protein 4 (SALL-4) in the nucleus of the tumor cells. [Original magnifications: (B, D, E) 100x; (C) 200x].
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The tumor was subtotally excised and measured to be 4.5 cmx 4.0 cm ( Figure 2A ). Immunohistochemical staining was positive for alpha-fetoprotein (AFP), PCK, CK8, CD99 and Sal-like protein 4 (SALL-4) and negative for Vimentin, CK7, GFAP, S-100, CD34, FLI-1, CD99, CD30 and epithelial membrane antigen (EMA) ( Figures 2B - E ).
Radiological evaluation of YST post operation. CT scanning of the residual tumor on day 7 (A). and two weeks after operation (B). The size of the residual tumor significantly decreased. Patchy hyperdense shadow was seen in the left cerebellar hemisphere, surrounded by patchy low-density edema. No obvious abnormalities were found in the ventricle or cisterns. Displacement of middle structure was not found.
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CT scanning of the residual tumor at 7 days and two weeks post operation showed that the tumor was significantly reduced ( Figure 3 ).