PMC5866897_01
CT scan and MRI at admission documented acute obstructive hydrocephalus caused by a pineal region mass.
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The computed tomographic (CT) scan and magnetic resonance imaging (MRI) demonstrated acute obstructive hydrocephalus due to a mass in the pineal region (maximum diameter of 1.5 cm) with signs of previous hemorrhage and without significative contrast enhancement (Figure 1).
Acute obstructive hydrocephalus 24 hours after EVD closure.
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On the fifth day after surgery, EVD was closed but 24 hours later, the patient showed neurological worsening with drowsiness and cognitive function decline; thus, EVD was reopened (Figure 2).
Intratumoral hemorrhage with mass expansion and complete occlusion of the third ventricle.
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MRI on the twelfth day after surgery demonstrated intratumoral hemorrhage with significative mass expansion, with blood in the third ventricle, and with mesencephalic aqueduct (Figure 3).
MRI after chemotherapy shows residual tumor mass. For this lesion, the patient underwent stereotactic radiosurgery.
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The patient underwent four cycles of bleomycin/etoposide/cisplatin (BEP) regimen, and the MRI at four months from surgery (Figure 4) showed reduction of mass volume and normal size of brain ventricles.
CT scan showing the new cerebral focal lesion.
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Anyway, two months later, he started to complain general malaise and gait imbalance, and the full-body CT scan showed increased intracerebral tumor mass with a new focal lesion and systemic metastasis involving the lungs, liver, and adrenal gland (Figures 5 and 6); the serum levels of beta-hCG were 12.713 UI/L.
CT scan of the thorax and abdomen showing the lung (green arrow), liver (red arrow), and left adrenal (blue arrow) lesions.
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Anyway, two months later, he started to complain general malaise and gait imbalance, and the full-body CT scan showed increased intracerebral tumor mass with a new focal lesion and systemic metastasis involving the lungs, liver, and adrenal gland (Figures 5 and 6); the serum levels of beta-hCG were 12.713 UI/L.