PMC6591517_01
Brain magnetic resonance imaging (MRI) of the patient performed at the age 10 years.
T2-weighted images. A, Abnormal, high signal intensity of the anterior part of the
corpus callosum is seen. B, The volume of the basal ganglia is asymmetric and reduced
with the hyperintense part of the left head of the caudate nuclei.
10.1177_2329048X19848181-fig1.jpg
PMC6591517_01_10.1177_2329048X19848181-fig1.jpg
fig1-2329048X19848181
Abnormal contrast enhancement of the optical chiasm and slight enlargement of the lateral ventricles was also visible (Figure 1).
First stereotactic biopsy: no neoplastic cells. Numerous macrophages visible.
10.1177_2329048X19848181-fig2.jpg
PMC6591517_01_10.1177_2329048X19848181-fig2.jpg
fig2-2329048X19848181
She underwent brain biopsy, but nonspecific activation of macrophages and no malignant cells were found (Figure 2).
Magnetic resonance imaging (MRI) examination performed 18 months later, after rituximab
administration. T2-weighted images. Focal hyperintense lesion in the right cerebral
hemisphere and small cystic lesions on the left side. Note diffuse cerebral atrophy.
Progression of lesions.
10.1177_2329048X19848181-fig3.jpg
PMC6591517_01_10.1177_2329048X19848181-fig3.jpg
fig3-2329048X19848181
Eighteen months after the onset of the symptoms, the follow-up serum examination revealed elevated alpha-fetoprotein level and brain MRI showed significant progression with new focal lesions with contrast enhancement suggesting neoplastic disease (Figure 3).
Second brain biopsy: H&E staining. Germinoma with large, anaplastic.
10.1177_2329048X19848181-fig4.jpg
PMC6591517_01_10.1177_2329048X19848181-fig4.jpg
fig4-2329048X19848181
The patient had another brain biopsy in which pure germinoma cells were found (Figure 4).
Brain magnetic resonance imaging (MRI) performed after second chemotherapy course.
Axial FLAIR image. Regression of the right focal lesion and the cerebral atrophy in both
gray and white matter more prominent in the front parts of the brain. Hyperintense
signal of the frontal white matter. Chronic, subdural hematoma in the frontal regions
bilaterally.
10.1177_2329048X19848181-fig5.jpg
PMC6591517_01_10.1177_2329048X19848181-fig5.jpg
fig5-2329048X19848181
She received chemotherapy with visible response on MRI (Figure 5); however, she developed serious adverse events: pancytopenia and renal failure followed with fatal disseminated intravascular coagulation.
Autopsy. Brain of the patient with visible atrophic changes.
10.1177_2329048X19848181-fig6.jpg
PMC6591517_01_10.1177_2329048X19848181-fig6.jpg
fig6-2329048X19848181
On autopsy, significant brain atrophy and no evidence of tumor were found (Figures 6 and 7).
Post-autopsy histopathology. Necrotic tissue with numerous macrophages and no presence
of neoplastic cells.
10.1177_2329048X19848181-fig7.jpg
PMC6591517_01_10.1177_2329048X19848181-fig7.jpg
fig7-2329048X19848181
On autopsy, significant brain atrophy and no evidence of tumor were found (Figures 6 and 7).