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case_images: Brain magnetic resonance imaging (MRI) of the patient performed at the age 10 years.
  T2-weighted images. A, Abnormal, high signal intensity of the anterior part of the
  corpus callosum is seen. B, The volume of the basal ganglia is asymmetric and reduced
  with the hyperintense part of the left head of the caudate nuclei.
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case_images: Abnormal contrast enhancement of the optical chiasm and slight enlargement of the lateral ventricles was also visible (Figure 1).
case_images: First stereotactic biopsy: no neoplastic cells. Numerous macrophages visible.
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case_images: She underwent brain biopsy, but nonspecific activation of macrophages and no malignant cells were found (Figure 2).
case_images: Magnetic resonance imaging (MRI) examination performed 18 months later, after rituximab
  administration. T2-weighted images. Focal hyperintense lesion in the right cerebral
  hemisphere and small cystic lesions on the left side. Note diffuse cerebral atrophy.
  Progression of lesions.
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case_images: Eighteen months after the onset of the symptoms, the follow-up serum examination revealed elevated alpha-fetoprotein level and brain MRI showed significant progression with new focal lesions with contrast enhancement suggesting neoplastic disease (Figure 3).
case_images: Second brain biopsy: H&E staining. Germinoma with large, anaplastic.
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case_images: The patient had another brain biopsy in which pure germinoma cells were found (Figure 4).
case_images: Brain magnetic resonance imaging (MRI) performed after second chemotherapy course.
  Axial FLAIR image. Regression of the right focal lesion and the cerebral atrophy in both
  gray and white matter more prominent in the front parts of the brain. Hyperintense
  signal of the frontal white matter. Chronic, subdural hematoma in the frontal regions
  bilaterally.
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case_images: She received chemotherapy with visible response on MRI (Figure 5); however, she developed serious adverse events: pancytopenia and renal failure followed with fatal disseminated intravascular coagulation.
case_images: Autopsy. Brain of the patient with visible atrophic changes.
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case_images: On autopsy, significant brain atrophy and no evidence of tumor were found (Figures 6 and 7).
case_images: Post-autopsy histopathology. Necrotic tissue with numerous macrophages and no presence
  of neoplastic cells.
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case_images: On autopsy, significant brain atrophy and no evidence of tumor were found (Figures 6 and 7).