Late recurrence of pineal germinoma.
BACKGROUND
Cerebral germinomas and their occasional recurrences can usually be cured by irradiation, chemotherapy, or a combination of the two treatment modalities. Late recurrences, as in our case, are distinctly rare.


METHODS
This patient presented at age 24 with a calcified tumor in the pineal area. The radiological diagnosis was germinoma. No tissue diagnosis was obtained. Radiation therapy was given, and there was a complete response. The patient's symptoms reappeared 13 years later. Imaging studies revealed a lesion in the anterior corpus callosum. A germinoma was diagnosed by stereotactic biopsy. Because of complications attributed to the initial course of radiation therapy, no further radiation was given. Five courses of chemotherapy resulted in a partial remission lasting six months. The patient later died because of massive tumor progression with intracerebral, intraventricular, cerebellar, and meningeal dissemination.


CONCLUSIONS
As this case illustrates, exceptional recurrences of cerebral germinomas may appear even many years after adequate initial treatment with radiation and chemotherapy.
Wenger
Markus
M
Department of Neurosurgery, University of Berne, Inselspital, Berne, Switzerland.
Lövblad
Karl O
KO
Markwalder
Regula
R
Taub
Ethan
E
D000328:Adult; D003131:Combined Modality Therapy; D017809:Fatal Outcome; D018237:Germinoma / Q000000981:diagnostic imaging* / Q000532:radiotherapy / Q000601:surgery; D006801:Humans; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local; D010871:Pinealoma / Q000000981:diagnostic imaging* / Q000532:radiotherapy / Q000601:surgery; D011859:Radiography; D013997:Time Factors