title: Mixed or metachronous germ-cell tumor?
abstract: OBJECTIVE
  We report the extremely rare occurrence of a second germ-cell tumor at a different site and with different histological types long after total resolution of a pineal germinoma.
  
  
  METHODS
  A 21-year-old man who presented with headache and diplopia was admitted to our hospital. Neuroradiological studies revealed a tumor in the pineal region. The tumor was biopsied with endoscope, and third ventriculostomy was performed. Histologically, the tumor proved to be a germinoma. The patient received 3 cycles of combination chemotherapy consisting of carboplatin and etoposide with radiotherapy. The tumor was totally resolute. Twelve months later, he was readmitted with headache and diplopia. Neuroradiological studies showed a tumor in the right temporal lobe.
  
  
  METHODS
  The second tumor was totally removed. Histologically, the tumor proved to be a mixed germ-cell tumor, which consisted a yolk-sac tumor and a germinoma. After the second course of chemotherapy, magnetic resonance image studies revealed no evidence of the tumor.
  
  
  CONCLUSIONS
  The second tumor was considered to be a metachronous neoplasm rather than a recurrence of the original mixed germ-cell tumor, which consisted a yolk-sac tumor and a germinoma.
authors.affiliation: Department of Neurosurgery, Brain Korea 21 Project for Medical Science, Brain Research Institute, Yonsei University College of Medicine, Seoul, South Korea.
authors.forename: Kyu-Won
authors.initials: KW
authors.lastname: Shim
authors.forename: Dong-Seok
authors.initials: DS
authors.lastname: Kim
authors.forename: Joong-Uhn
authors.initials: JU
authors.lastname: Choi
mesh_terms: D000328:Adult; D001932:Brain Neoplasms / Q000150:complications / Q000473:pathology* / Q000628:therapy; D018240:Endodermal Sinus Tumor / Q000150:complications / Q000473:pathology* / Q000628:therapy; D018237:Germinoma / Q000150:complications / Q000473:pathology* / Q000628:therapy; D006801:Humans; D008297:Male; D009378:Neoplasms, Multiple Primary / Q000473:pathology* / Q000628:therapy; D010871:Pinealoma / Q000150:complications / Q000473:pathology* / Q000628:therapy; D013702:Temporal Lobe / Q000473:pathology* / Q000601:surgery; D014696:Ventriculostomy