PMC9751951_01
Computed tomography (CT), magnetic resonance imaging (MRI), and pathological findings of Case 1. An abdominal CT scan shows a tumor in the right ovary, in which calcification and fat were observed, and suggests an ovarian teratoma (arrowhead) (A). Chest CT scan shows a nodule (9 mm in diameter) in the right lung (arrowhead) (B). Hematoxylin and eosin (H&E) staining of the lung nodule section indicates adenocarcinoma (C). The lung nodule section stained with aquaporin-4 (AQP-4)-specific monoclonal antibody (sc-32739, Santa Cruz, United States of America) shows intense immunoreactivity on adenocarcinoma cells (D). Fluid-attenuated inversion recovery (FLAIR) images of the brain display hyperintense symmetrical lesions in the thalamus, hypothalamus (E), and area postrema (F) when the patient was first present in our department (arrowhead). These lesions disappeared 6 months later (G,H).
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F1
The patient underwent left ovarian teratoma ablation at the age of 23 years, and she was confirmed to have teratoma in the right ovary when she was 26 years old but did not receive any treatment (Figure 1A). Brain magnetic resonance imaging (MRI) showed fluid-attenuated inversion recovery (FLAIR) hyperintense and contrast-enhancing lesions in the thalamus, hypothalamus, and area postrema (Figures 1E,F). Six months later, her visual and hearing symptoms progressively improved, and the lesions on the cerebral MRI disappeared (Figures 1G,H). However, the treatment was postponed because of the nodule in her right lung (Figure 1B). She underwent resection of the nodule in the Department of Cardiothoracic Surgery and was pathologically proven to have a lung adenocarcinoma (Figure 1C) and a high AQP-4 expression (Figure 1D).
PMC9751951_02
Magnetic resonance imaging (MRI) and pathological findings of Case 2. T2-weighted MRIs show abnormal signals in the cervical and thoracic spinal cord (arrowhead) (A,B). An abdominal computed tomography (CT) shows a tumor in the right ovary, in which calcification and fat were observed, and suggests an ovarian teratoma (arrowhead) (C). Hematoxylin and eosin (H&E) staining of teratoma section (D). Teratoma section stained with aquaporin-4 (AQP-4)-specific monoclonal antibody shows intense immunoreactivity (E).
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F2
Spine MRI displayed T2 hyperintense segmental extensive lesions in the cervical and thoracic spinal cord (Figures 2A,B). An abdominal CT demonstrated a right ovary mass which was pathologically proved to be a mature teratoma (Figures 2C,D). Moreover, AQP-4 expression was detected in the teratoma by immunohistochemistry staining (Figure 2E).
PMC9751951_03
Magnetic resonance imaging (MRI), barium enema, and pathological findings of Case 3. T2-weighted MRIs show abnormal signals in the cervical spinal cord (A) and T2-weighted fat-suppressed MRI displayed hyperintensity in bilateral optic nerves (B) (arrowhead). Barium enema shows truncation of the transverse colon (C). Hematoxylin and eosin (H&E) staining of the transverse colon tumor section (D). Aquaporin-4 (AQP-4)-specific monoclonal antibody staining of the transverse colon tumor section shows intense immunoreactivity (E).
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F3
The MRI showed T2 hyperintense signals in the cervical spinal cord (C4-6) (Figure 3A) and hyperintensity of bilateral optic nerves on T2-weighted fat-suppressed MRI (Figure 3B). Barium enema indicated local truncation of the transverse colon (Figure 3C). The biopsy of the tumor was consistent with that before (Figure 3D). AQP4 staining of the adenocarcinoma was positive (Figure 3E).