case_images: PMC10812115_01
case_images: Genetic analysis.
case_images: fgene-14-1286515-g001.jpg
case_images: PMC10812115_01_fgene-14-1286515-g001.jpg
case_images: F1
case_images: Genetic testing in March 2023 revealed the presence of 46,X,del(Xp22.33-11.23), involving a 47.6-Mb deletion, along with del(2)(q11.1-11.2), characterized by a 1.5-Mb deletion (Figure 1).
case_images: Magnetic resonance imaging and radical surgery.
case_images: fgene-14-1286515-g002.jpg
case_images: PMC10812115_01_fgene-14-1286515-g002.jpg
case_images: F2
case_images: An MRI investigation also exhibited a 17.0 cm x 20.0 cm x 10.5 cm solid ovarian lesion and uterus didelphys (Figure 2), whereas cranial and pulmonary CT examinations yielded unremarkable findings. In March 2023, the patient underwent radical surgery, in which pathology verified dysgerminoma at stage IIIc with lymphatic metastases (Figure 2).
case_images: Analysis of the microenvironment in dysgerminoma.
case_images: fgene-14-1286515-g003.jpg
case_images: PMC10812115_01_fgene-14-1286515-g003.jpg
case_images: F3
case_images: Subsequent immunohistochemistry analysis of sequentially sectioned tumor slides demonstrated the robust expression of CD4+ T cells and programmed cell death protein 1 (PD-1) within the tumor microenvironment (TME), whereas staining of CD8+ T cells and programmed death-ligand 1 (PDL-1) showed sporadic distribution (Figure 3).
case_images: Magnetic resonance imaging and magnetic resonance angiography before and after chemotherapy.
case_images: fgene-14-1286515-g004.jpg
case_images: PMC10812115_01_fgene-14-1286515-g004.jpg
case_images: F4
case_images: Before the onset of chemotherapy, an evaluation at our hospital in May 2023 via intracranial MRI and MRA exhibited previously infarcted foci, highly suspected metastatic loci, and the circle of Willis malformation (Figure 4). Despite the daily administration of enoxaparin at a dose of 4,000 IU (40 mg) to prevent thromboembolism, multiple intracranial infarctions reoccurred (Figure 4) 5 days after commencing the standard chemotherapy regime using bleomycin, etoposide, and cisplatin.