Mission impossible: chemotherapy in the intensive care for pineal region germ cell tumor

A 21-year-old male was admitted to our department with headache and drowsiness. CT scan and MRI revealed acute obstructive hydrocephalus caused by a pineal region mass. The serum and CSF levels of beta-human chorionic gonadotropin (beta-hCG) were 215 IU/L and 447 IU/L, respectively, while levels of alpha-fetoprotein (AFP) were normal. A germ cell tumor (GCT) was suspected, and the patient underwent endoscopic third ventriculostomy (ETV) with biopsy. After four days from surgery, the tumor bled with mass expansion and ETV stoma occlusion; thus, a ventriculoperitoneal shunt was positioned. After ten months, the tumor metastasized to the thorax and abdomen with progression of intracerebral tumor mass. Despite the aggressive nature of this tumor, ETV remains a valid approach for a pineal region mass, but in case of GCT, the risk of bleeding should be taken into account, during and after the surgical procedure.

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Absence of isochromosome 12p in a pineal region malignant germ cell tumor

Cancer Genetics and Cytogenetics ◽

10.1016/0165-4608(90)90249-a ◽

1990 ◽

Vol 50 (1) ◽

pp. 153-160 ◽

Cited By ~ 25

Author(s):

Violet Shen ◽

Michael Chaparro ◽

Byung H. Choi ◽

Ronald Young ◽

Renee Bernstein

Keyword(s):

Germ Cell ◽

Germ Cell Tumor ◽

Pineal Region ◽

Cell Tumor ◽

Isochromosome 12P ◽

Malignant Germ Cell Tumor

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Mixed germ-cell tumor of the pineal region

Journal of Neurosurgery ◽

10.3171/jns.1987.66.2.0300 ◽

1987 ◽

Vol 66 (2) ◽

pp. 300-304 ◽

Cited By ~ 23

Author(s):

Stephen L. Graziano ◽

Frank P. Paolozzi ◽

Alfred R. Rudolph ◽

William A. Stewart ◽

Ahmad Elbadawi ◽

...

Keyword(s):

Germ Cell ◽

Germ Cell Tumor ◽

Serum Levels ◽

Pineal Region ◽

Cell Tumor ◽

Subtotal Resection ◽

Content Type ◽

Mixed Germ Cell Tumor ◽

Nongerminomatous Germ Cell Tumor ◽

Modality Approach

✓ The case is presented of a 15-year-old boy with a mixed nongerminomatous germ-cell tumor of the pineal region associated with elevated cerebrospinal fluid and serum levels of the beta subunit of human chorionic gonadotropin. Treatment consisted of initial subtotal resection followed by radiotherapy and systemic chemotherapy with cisplatin, vinblastine, and bleomycin. The patient is alive without evidence of tumor 37 months after his initial diagnosis. A literature review of intracranial embryonal carcinoma and choriocarcinoma provided the rationale for a combined-modality approach to this otherwise lethal neoplasm.

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Control of extraneural metastasis of a primary intracranial nongerminomatous germ-cell tumor

Journal of Neurosurgery ◽

10.3171/jns.1989.71.4.0601 ◽

1989 ◽

Vol 71 (4) ◽

pp. 601-604 ◽

Cited By ~ 19

Author(s):

Jan Watterson ◽

John R. Priest

Keyword(s):

Germ Cell ◽

Germ Cell Tumor ◽

Germ Cell Tumors ◽

Whole Brain Radiotherapy ◽

Pineal Region ◽

Cell Tumor ◽

High Dose ◽

Content Type ◽

Extraneural Metastasis ◽

Fine Print

✓ Primary intracranial germ-cell tumors are infrequently occurring neoplasms which most often arise in the pineal or sellar regions. Germinomas are seen more frequently than nongerminomatous germ-cell tumors; they are often curable with radiotherapeutic approaches, or with chemotherapy in the rare instance of extraneural metastasis. Nongerminomatous germ-cell tumors are relatively radioresistant and when extraneural metastasis has occurred, they have been fatal in all of the 32 previously reported cases. The case of a 14-year-old girl with a mixed malignant germ-cell tumor arising in the pineal region is reported. Extraneural metastasis to the lung developed 12 months after whole-brain radiotherapy was completed. She was treated with etoposide (VP-16), high-dose cisplatin, vinblastine, and bleomycin and is currently without evidence of disease 46 months postmetastasis.

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