case_images: PMC11807994_01
case_images: (A) Preoperative non-contrast-enhanced CT revealed a right lateral ventricle lesion with calcium in right rim (orange arrow). There were many low-density signals in bi-lateral ventricles and subarachnoid space likely oil or air (yellow arrows). (B) Axial T1-weighted MRI images demonstrated multiple hyperintense signals, oily globules, in ventricles and subarachnoid space (yellow arrows). Axial T2-weighted MRI images showed a lesion with mixed signal in the right lateral ventricle and septum pellucidum (C, axial; D, sagittal). T1-enhanced MRI images revealed heterogeneous enhancement of the lateral ventricle lesion and strong enhancement of septum pellucidum lesion (E, axial; F, sagittal; G, coronal). (H) The oily substances floating in CSF were observed during microsurgery. (I) The lesion containing cottage-cheese-like material was removed during microsurgery. (K) Gross total resection of the lesion during microsurgery. The oily substances in the cup (J) and the resected lesion (L) were demonstrated. (M) Paraffin section of this lesion confirmed mature teratoma. (N) Axial T1-weighted MRI image at day 1 after surgery revealed oily globules in ventricles and subarachnoid space (yellow arrows). (O) T1-enhanced MRI images at day 1 after surgery confirmed the gross total resection of the tumor. (P) T1-enhanced MRI images in 15 months after discharge showed no recurrence.
case_images: fonc-14-1493982-g001.jpg
case_images: PMC11807994_01_fonc-14-1493982-g001.jpg
case_images: f1
case_images: Scattered oily substrates with an attenuation value of -110 HU were seen in the ventricles and subarachnoid space, suggesting tumor rupture ( Figure 1A ). Figure 1B ) and hyperintense on T2-weighted images ( Figures 1C, D ). Fat suppression MRI was not performed preoperatively. MRI revealed a right lateral ventricle mass measuring 6 cm x 4 cm x 3.5 cm that extended to the septum pellucidum, causing obstructive hydrocephalus ( Figures 1C, D ). The lesion enhanced heterogeneously after contrast substance administration ( Figures 1E-G ). The ventricular needle was punctured approximately 5 cm into the subcortical matter, allowing CSF mixed with lipid-like droplets to flow out ( Figure 1H ). The lipid lesions had a cheese-like consistency ( Figures 1I, J ), and some softer parts contained glial components. Histopathological results confirmed a mature teratoma ( Figure 1M ). Postoperative day 1 cranial MRI confirmed complete tumor resection with no residual enhancing lesions ( Figures 1N, O ). She did not present any symptoms or recurrence of the tumor after a 15-month follow-up ( Figure 1P ).