PMC8163630_01
MRI scan of the brain at presentation. This MRI scan image showed two notable nodules in the cerebellopontine angle area and the medial temporal horn of the left ventricle (black arrow).
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Cranial magnetic resonance imaging (MRI) showed two notable nodules in the cerebellopontine angle area and the medial temporal horn of the left ventricle (Figure 1). A panel of 222 common genes were tested (Figure S1), and the examination revealed multiple abnormalities in the surgical specimen (Table 1).
Treatment procedure, and timeline of symptoms during the treatment. MRI1, first MRI scan; MRI2, second MRI scan; MRI3, third MRI scan; MRI4, fourth MRI scan; bid, twice daily.
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The patient was started on a HD-MTX-based regimen for two courses (Figure 2). The treatment was well tolerated, and symptoms were relieved gradually (Figure 2).
Cranial MRI images. (A and B) Cranial MRI imaging on admission to the department of hematology. (C and D) Cranial contrast-enhanced MRI imaging on the day before the third course showed that the mass in the cerebellopontine angle area had clearly enlarged. (E and F) Cranial contrast-enhanced MRI imaging on the day before the fourth course showed that the mass was reduced significantly. (G and H) Cranial contrast-enhanced MRI imaging on the day before the fifth course showed that the mass disappeared with cicatricial changes.
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Even though the mass in the medial temporal horn of the left ventricle shrank slightly (not shown here), the mass in the cerebellopontine angle area clearly enlarged (Figure 3). Two additional courses were given, and a CR with cicatricial changes was achieved after three courses of chemotherapy with the new regimen (Figure 3).