title: Pineal germinoma with a prominent epithelioid cell granuloma component: case report.
abstract: A 20-year-old man presented with a rare case of germinoma with a large component of epithelioid cell granuloma manifesting as oscillopsia. Magnetic resonance imaging demonstrated a mass in the pineal region with homogeneous enhancement with gadolinium. Craniotomy was performed, ending in biopsy. The initial histological diagnosis was epithelioid cell granuloma, but systemic investigation detected no evidence of granulomatous disorder. A revised diagnosis of germinoma was based on positive immunohistochemical staining for placental alkaline phosphatase (PLAP) and c-kit. Histological diagnosis is sometimes incorrect if granulomatous reaction is dominant. Immunohistochemical staining for PLAP and c-kit should be performed if germinoma is clinically suspected.
authors.affiliation: Department of Neurosurgery, Jikei University School of Medicine, Daisan Hospital, Komae, Tokyo, Japan. ryotam@jikei.ac.jp
authors.forename: Ryosuke
authors.initials: R
authors.lastname: Mori
authors.forename: Masato
authors.initials: M
authors.lastname: Nakajima
authors.forename: Haruo
authors.initials: H
authors.lastname: Sakai
authors.forename: Masaharu
authors.initials: M
authors.lastname: Fukunaga
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Abe
mesh_terms: D000469:Alkaline Phosphatase; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D014408:Biomarkers, Tumor / Q000032:analysis; D002945:Cisplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy; D016371:Cranial Irradiation; D003399:Craniotomy; D003951:Diagnostic Errors; D015622:Epithelioid Cells / Q000737:chemistry / Q000473:pathology*; D005047:Etoposide / Q000008:administration & dosage; D058851:GPI-Linked Proteins; D018237:Germinoma / Q000737:chemistry / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy; D006099:Granuloma / Q000175:diagnosis* / Q000473:pathology; D006644:Histiocytes / Q000737:chemistry / Q000473:pathology; D006801:Humans; D007527:Isoenzymes / Q000032:analysis; D007801:Langerhans Cells / Q000737:chemistry / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D009363:Neoplasm Proteins / Q000032:analysis; D010871:Pinealoma / Q000737:chemistry / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy; D019009:Proto-Oncogene Proteins c-kit / Q000032:analysis; D012074:Remission Induction; D055815:Young Adult
chemical_list: D014408:Biomarkers, Tumor; D058851:GPI-Linked Proteins; D007527:Isoenzymes; D009363:Neoplasm Proteins; D005047:Etoposide; D019009:Proto-Oncogene Proteins c-kit; D000469:Alkaline Phosphatase; C019839:alkaline phosphatase, placental; D002945:Cisplatin