case_images: PMC3161680_01
case_images: Brain MRI. The solitary metastatic lesion was shown, which was 4.5 cm x 3 cm in diameter, occupying the left occipital lobe (before operation).
case_images: cmo-2-2008-371f1.jpg
case_images: PMC3161680_01_cmo-2-2008-371f1.jpg
case_images: f1-cmo-2-2008-371
case_images: The brain lesion had grown rapidly (Fig. 1), and serum tumor markers were elevated, including lactate dehydrogenase (LDH) at 447 U/l (normal, 118-236), alphafetoprotein (AFP) at 480 ng/ml (normal  10), and human chorionic gonadotropin (HCG) at 629 IU/l (normal  1.0).
case_images: H&E staining showed solid and tubular tumor cells with large, bizarre nuclei, coexisted with hemorrhage (magnification, x 100). Immunohistochemical staining showed tumor cells to be positive with CD30 and AFP that suggested the embryonal carcinoma with yolk sac tumor component, and partially positive with HCG, suggesting syncytiotrophoblastic cells.
case_images: cmo-2-2008-371f2.jpg
case_images: PMC3161680_01_cmo-2-2008-371f2.jpg
case_images: f2-cmo-2-2008-371
case_images: On pathology, the tumor was diagnosed as metastatic embryonal carcinoma and yolk sac tumor (Fig. 2).
case_images: MRI of the spinal cord before and after salvage chemotherapy. 3A-Well-enhanced, multiple leptomeningeal metastases were detected at the 2nd and 12th thoracic cord levels, as well as at the 1st sacral cord level (Th2, Th12, and S1) (white arrows). 3B-Complete remission of the leptomeningeal metastases was demonstrated after salvage chemotherapy.
case_images: cmo-2-2008-371f3.jpg
case_images: PMC3161680_01_cmo-2-2008-371f3.jpg
case_images: f3-cmo-2-2008-371
case_images: On magnetic resonance imaging (MRI), multiple leptomeningeal metastases with no brain recurrence were seen (Fig. 3A). After four courses of therapy, the leptomeningeal lesions disappeared (Fig. 3B).