case_images: PMC5866897_01
case_images: CT scan and MRI at admission documented acute obstructive hydrocephalus caused by a pineal region mass.
case_images: CRIM2018-5106701.001.jpg
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case_images: fig1
case_images: 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).
case_images: Acute obstructive hydrocephalus 24 hours after EVD closure.
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case_images: PMC5866897_01_CRIM2018-5106701.002.jpg
case_images: fig2
case_images: 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).
case_images: Intratumoral hemorrhage with mass expansion and complete occlusion of the third ventricle.
case_images: CRIM2018-5106701.003.jpg
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case_images: fig3
case_images: 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).
case_images: MRI after chemotherapy shows residual tumor mass. For this lesion, the patient underwent stereotactic radiosurgery.
case_images: CRIM2018-5106701.004.jpg
case_images: PMC5866897_01_CRIM2018-5106701.004.jpg
case_images: fig4
case_images: 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.
case_images: CT scan showing the new cerebral focal lesion.
case_images: CRIM2018-5106701.005.jpg
case_images: PMC5866897_01_CRIM2018-5106701.005.jpg
case_images: fig5
case_images: 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.
case_images: CT scan of the thorax and abdomen showing the lung (green arrow), liver (red arrow), and left adrenal (blue arrow) lesions.
case_images: CRIM2018-5106701.006.jpg
case_images: PMC5866897_01_CRIM2018-5106701.006.jpg
case_images: fig6
case_images: 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.