case_images: PMC3463838_01
case_images: Preoperative computed tomography (CT) (a) showed a large tumor with inhomogeneous density compressing cerebellum. Hydrocephalus was present with periventricular lucency. It is also inhomogeneous and multiloculated on T1-weighted (b) and T2-weighted (c) magnetic resonance images (MRIs). Gadolinium enhanced MRI (d-f) showed heterogeneous enhancement effect
case_images: SNI-3-100-g001.jpg
case_images: PMC3463838_01_SNI-3-100-g001.jpg
case_images: F1
case_images: Computed tomography (CT) [Figure 1a] of the brain showed a large heterogeneously dense midline posterior fossa tumor, 5 cm in diameter, involving the cerebellum. T1- and T2-weighted magnetic resonance images (MRI) and consisted of various sized cysts [Figure 1b and c]. The tumor strongly enhanced with gadolinium and was multiloculated [Figure 1d-f].
case_images: Postoperative axial (a), sagital (b), and coronal (c) MRIs revealed the total resection of tumor with improvement of the hydrocephalus state. Note pineal gland remained intact (arrow)
case_images: SNI-3-100-g002.jpg
case_images: PMC3463838_01_SNI-3-100-g002.jpg
case_images: F2
case_images: Postoperative MRI showed the total removal of the tumor [Figure 2a-c].
case_images: Histological patterns showed canalicullar structure resembling a developing neural tube or neuroephitelial rosettes (a). These patterns showed positive reaction with alpha-fetoprotein (AFP) immunostaining (B). Neuroepithelial rosettes react positively with beta-tubulin 3 (c), and MAP2 (d). GFAP immunostaining was negative (e). The MIB 1 index was approximately 10% (f). (a) H and E, x100; (b-f) x100 (original magnification). Barr showed 100 mum
case_images: SNI-3-100-g003.jpg
case_images: PMC3463838_01_SNI-3-100-g003.jpg
case_images: F3
case_images: The most immature elements were primitive embryonal mesenchymal tissue or neuroectodermal tissue with canalicular structure resembling a developing neural tube or neuroepithelial rosettes [Figure 3a]. This tumor showed a positive reaction to AFP immunostaining [Figure 3b]. Neuroepithelial rosettes reacted positively to beta-tubulin 3 and MAP2 [Figure 3c and d]. Glial fibrillary acidic protein (GFAP) immunostaining was negative [Figure 3e]. The MIB-1 index was approximately 10% [Figure 3f].
case_images: PMC3463838_02
case_images: Two recurrent tumors (arrows) were found on axial (a), sagital (b), and coronal (c) MRIs obtained 10 months after the first surgery. The latest axial (d), sagital (e), and coronal (f) MRIs studied 3 years after the second operation showed no recurrence
case_images: SNI-3-100-g004.jpg
case_images: PMC3463838_02_SNI-3-100-g004.jpg
case_images: F4
case_images: In addition, it had dropped to 1.25 x 104 UI/L when two recurrent lesions were detected in the cerebellar vermis and tentorium on MRI [Figure 4a-c], performed 10 months after the first surgery. The latest MRI studied 3 years after the second surgery [Figure 4d-f] showed no recurrences.