PMC8769452_01
Coronal chest contrast-enhanced CT scans obtained before chemotherapy (A and D), 2 weeks after the start of chemotherapy (B and E), and after three courses of chemotherapy (C and F). Dotted arrows, arrows, and arrowheads indicate the nodule in the right upper lung field, mediastinal lymph node, and lymph nodes located between the recurrent laryngeal nerve and the right common carotid artery, respectively.
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F1
Chest CT demonstrated a large nodule in the upper right lung field and swelling of multiple bilateral pulmonary and mediastinal lymph nodes (Fig. 1A and 1D). MRI and CT obtained 2 weeks after the start of CARE therapy demonstrated apparent shrinkage of suprasellar and pineal tumors, a nodule in the upper right lung field, and the mediastinal lymph nodes (Fig. 1B and 1E). CARE therapy and whole ventricle irradiation 23.4 Gy showed complete disappearance of the intracranial bifocal tumors (Fig. 2D-F). Chest CT demonstrated shrinkage of some mediastinal lymph nodes, but a progression of the nodule in the right upper lung and swelling of the lymph nodes located between the recurrent laryngeal nerve and the right common carotid artery (Fig. 1C and 1F).
Contrast-enhanced MRIs obtained before chemotherapy (A-C) and after three courses of chemotherapy and irradiation (D-F). (A, B, D, and E) Axial images, (C and F) midsagittal images.
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F2
MRI demonstrated bifocal pineal and suprasellar tumor with obstructive hydrocephalus (Fig. 2A-C). CARE therapy and whole ventricle irradiation 23.4 Gy showed complete disappearance of the intracranial bifocal tumors (Fig. 2D-F). Chest CT demonstrated shrinkage of some mediastinal lymph nodes, but a progression of the nodule in the right upper lung and swelling of the lymph nodes located between the recurrent laryngeal nerve and the right common carotid artery (Fig. 1C and 1F).
Photomicrographs of hematoxylin and eosin staining ((A, G) original magnification x200; (D) original magnification x100), and immunohistochemical staining (original magnification x400) for c-KIT (B and E) and placental alkaline phosphatase (C and F) of the biopsied specimens from the pineal lesion (A-C), from the mediastinum lymph nodes obtained by endoscopic ultrasound-guided fine needle aspiration before chemotherapy (D-F), and from the mediastinum lymph node specimen obtained by transbronchial lung biopsy after three courses of chemotherapy (G).
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F3
The pathological diagnosis was pure germinoma of the intracranial bifocal tumor (Fig. 3A-C). In contrast, only epithelioid granuloma was found in the mediastinal lymph nodes (Fig. 3D), which were immunohistologically negative for c-KIT (Fig. 3E) and placental alkaline phosphatase (Fig. 3F). Histological examination of specimens from the right upper lung mass showed epithelioid granuloma with multinucleated giant cells (Fig. 3G).
Whole-body fluorine-18-fluorodeoxyglucose positron emission tomography image.
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F4
Whole-body fluorine-18-fluorodeoxyglucose positron emission tomography (FDG-PET) demonstrated accumulation in the mediastinal lymphadenopathy, lung masses, and multiple lymph nodes of the whole body (Fig. 4).