title: Intrathecal and intraperitoneal germinomas occurring 20 years after total removal of a pineal teratoma. Case report.
abstract: In 1980, a 10-year-old boy was admitted to the authors' hospital with consciousness disturbance and vomiting. Computerized tomography (CT) scans revealed a pineal mass lesion and hydrocephalus. The tumor was totally removed and a ventriculoperitoneal (VP) shunt was inserted. Histological investigation of a surgical specimen revealed that it was a teratoma. Five years later, the patient was readmitted to the same institution with polyuria. Magnetic resonance (MR) imaging revealed a mass lesion in the suprasellar region. The patient received systemic chemotherapy, and the tumor disappeared; however, 2 years after the chemotherapy, MR imaging demonstrated a right lateral ventricular mass. The tumor was totally resected, and histopathological investigation revealed a teratocarcinoma. Three years after the chemotherapy, CT scanning revealed suprasellar and right lateral ventricular tumor recurrences, for which the patient received irradiation and chemotherapy. The tumors disappeared and the patient achieved complete remission that lasted longer than 10 years. On January 25, 2000, however, he noticed hip pain. Lumbar MR imaging demonstrated a spinal tumor below L-4 and also an abdominal tumor. The abdominal tumor was totally removed, and the histological findings identified it as a germinoma. The patient received systemic chemotherapy and the tumor disappeared completely. The authors believe that the suprasellar tumor was a metachronous germinoma and that it had metastasized through the intrathecal route and the VP shunt.
authors.affiliation: Department of Neurosurgery and Surgery, Fukui Red Cross Hospital, Japan. yiwamuro@tc4.so-net.ne.jp
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Iwamuro
authors.forename: Satoru
authors.initials: S
authors.lastname: Seo
authors.forename: Yuki
authors.initials: Y
authors.lastname: Hirose
authors.forename: Junya
authors.initials: J
authors.lastname: Jito
authors.forename: Mitsuaki
authors.initials: M
authors.lastname: Shirahata
authors.forename: Tomoo
authors.initials: T
authors.lastname: Tokime
authors.forename: Kazuo
authors.initials: K
authors.lastname: Hosotani
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Tokuriki
mesh_terms: D000008:Abdominal Neoplasms / Q000473:pathology* / Q000628:therapy*; D000293:Adolescent; D000328:Adult; D001932:Brain Neoplasms / Q000473:pathology* / Q000628:therapy*; D002648:Child; D018237:Germinoma / Q000473:pathology* / Q000628:therapy*; D006801:Humans; D008297:Male; D016609:Neoplasms, Second Primary / Q000473:pathology* / Q000628:therapy*; D010870:Pineal Gland / Q000473:pathology*; D013724:Teratoma / Q000473:pathology* / Q000628:therapy*; D013997:Time Factors; D017287:Ventriculoperitoneal Shunt