PMC6935970_01
(a) Contrast computed tomography preoperative imaging of jejunum. (b) Pathology of the primary jejunum lesion, hematoxylin- eosin (HE) staining, low magnification. Poorly differentiated small bowel adenocarcinoma is proliferating solidly. The scale bar is 250 microm. (c) Pathology of the primary jejunum lesion, HE staining, high magnification. There was nuclear atypia, pleomorphism, and prominent nucleoli. The scale bar is 250 microm. (d) Jejunum tumor (red arrow), invading transverse colon (black arrow). (e) Pathology of the cerebellum lesion, HE staining, low magnification. Cerebellum histopathology is seen in the lower right of the screen; there is poorly differentiated adenocarcinoma metastasis. The scale bar is 250 microm. (f) Pathology of the cerebellum lesion, HE staining, high magnification. The histopathological feature of the left cerebellum lesion coincided with that of the primary jejunum lesion. There were nuclear atypia, pleomorphism, and prominent nucleoli. The pathological diagnosis was poorly differentiated small bowel adenocarcinoma metastasis. The scale bar is 50 microm.
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F1
Pathological diagnosis was poorly differentiated adenocarcinoma, pT4N2M0 Stage IIIB [UICC-TNM: 8th edition; Figure 1a,b,c,d].
The contents of the cerebellum cyst were old brownish hematoma-like liquid (a), and partially nodular lesions were inside the cyst (b; arrow). Preoperative magnetic resonance imaging (MRI) of cerebellar metastasis lesion (c: T1WI MRI with contrast, d: T1WI, e: T2WI, f: Fluid-attenuated inversion recovery).
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F2
Postoperative MRI revealed total removal of the tumor; thus, according to the results of the JCOG 0504 trial, we chose close observation without additional radiotherapy [Figures 2c-f and 3a].
T1WI magnetic resonance imaging with contrast (a: 1 postoperative day, b: 1 month after operation). Computed tomography, hemorrhage from the cerebellar metastasis recurrent lesion (c, left and d, right).
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F3
Postoperative MRI revealed total removal of the tumor; thus, according to the results of the JCOG 0504 trial, we chose close observation without additional radiotherapy [Figures 2c-f and 3a]. A month later, periodical MRI revealed obstructive hydrocephalus accompanying the recurrence of brain tumor [Figure 3b]. Ventricular drainage was scheduled in case the symptoms worsened, but he suddenly died the next day due to cerebral hernia caused by intratumoral hemorrhage [Figure 3c,d].