title: Synchronous mixed germ cell tumor of the pineal gland and suprasellar region with a predominant angiomatous component: a diagnostic challenge.
abstract: We present a case of synchronous involvement of the pineal and suprasellar regions by a mixed germ cell tumor comprising germinoma and yolk sac tumor components, with a predominant angiomatous component. To our knowledge, it is the first case of this nature to be reported in the literature. Usually, synchronous lesions of this kind are pure germinomas, and some clinicians will forgo a biopsy and assume a germinoma histology if the serum beta-human chorionic gonadotrophin (HCG) is <50 IU/l and the alpha-fetoprotein (AFP) is within normal limits. Secondly, if a biopsy is performed on a lesion that has a prominent angiomatous component, the diagnostic germ cell tumor may be missed at the time of the biopsy. In order to alert clinicians and pathologists to this rare entity, the case is discussed with particular reference to difficulties that were encountered in rendering an accurate diagnosis, and the associated management implications.
authors.affiliation: Department of Pathology, New York University Medical Center, New York, 10016, USA. clare@drcunliffe.com
authors.forename: Clare H
authors.initials: CH
authors.lastname: Cunliffe
authors.forename: Ingeborg
authors.initials: I
authors.lastname: Fischer
authors.forename: Matthias
authors.initials: M
authors.lastname: Karajannis
authors.forename: David
authors.initials: D
authors.lastname: Monoky
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Allen
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Wisoff
authors.forename: David
authors.initials: D
authors.lastname: Zagzag
mesh_terms: D000293:Adolescent; D001706:Biopsy; D006801:Humans; D006849:Hydrocephalus / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D009373:Neoplasms, Germ Cell and Embryonal / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery; D010870:Pineal Gland / Q000473:pathology* / Q000601:surgery; D010871:Pinealoma / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery; D016896:Treatment Outcome