case_images: PMC10761546_01
case_images: Pathological examination of this renal mass indicates the presence of clear cell renal cell carcinoma. (A) The tumor is arranged in vesicular or nested clusters, with numerous interstitial capillaries, a clear cytoplasm (original magnification x100), and (B) conspicuous and eosinophilic nucleoli (original magnification x400). (C) Tumor cells that are positive for vimentin (original magnification x100). (D) Tumor cells that are positive for CD10 (original magnification x100). (E) Tumor cells that are positive for PAX2 (original magnification x100). (F) Tumor cells that are positive for PAX8 (original magnification x100).
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case_images: The patient had undergone laparoscopic partial right nephrectomy for renal clear-cell carcinoma 5 months prior ( Figure 1 ).
case_images: MRI imaging of the patient before and after treatment. (A) Brain MRI showed abnormal signals around the mesencephalic aqueduct and the pontine brain on the T2-FLAIR sequence. (C) Spinal cord MRI revealed spinal cord lesions in the C6-C7 and T2-T3 segments on the T2 sequence. (B, D) After treatment, the patient's intracranial lesions had almost disappeared.
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case_images: MRI revealed lesions in the C6-C7 and T2-T3 segments on the T2 sequence ( Figures 2A, C ). Moreover, the electroencephalogram was normal, ruling out epilepsy. On repeat head MRI, the patient's intracranial lesions had almost disappeared ( Figure 2B ). After 2 months of treatment, a follow-up examination showed that the patient's spinal cord lesions had disappeared ( Figure 2D ).
case_images: The patient's sleep architecture before and after treatment. W = wakefulness; R = rapid eye movement (REM) sleep; N1, N2, and N3 = non-REM N1, N2, and N3 sleep stages. (A) The 24-hour PSG result of the patient before treatment, showing a total sleep time of 539.5 min. (B) Overnight PSG revealed a total sleep time of 393 min after treatment. (C) MSLT followed the overnight PSG and revealed 4 consecutive sleep-onset rapid eye movement periods.
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case_images: In this case, the patient's sleepiness was too severe to perform MSLT; therefore, the patient underwent 24-hour PSG, which showed a total sleep time of 539.5 minutes ( Figure 3A ), sleep latency of 8.5 minutes, rapid-eye-movement sleep without atonia, and dream enactment behavior. Repeated PSG revealed a total sleep time of 393 min ( Figure 3B ), with a decrease in AHI to 26.4 times/h, and only obstructive respiratory events were observed. The MSLT indicated a mean sleep latency of 6.3 min (normal >8 min) and the occurrence of four consecutive SOREMPs ( Figure 3C ).
case_images: Cell-based indirect immunofluorescence assays demonstrate positivity for GFAP IgG antibodies. (A) Positive control with human GFAP IgG. (B) Negative control in a healthy individual. (C) Positive result in the CSF (titer at 1:32). (D) Negative result in serum.
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case_images: Additionally, glial fibrillary acidic protein (GFAP) IgG antibodies were found to be positive in the CSF (1:32, cell-based assay) but not in the serum ( Figure 4 ), whereas AQP4 antibodies and MOG antibodies were negative in both the CSF and serum.