Mixed germ cell tumor of the midbrain. Case Report.
This 14-year-old boy presented with left hemiparesis, gait disturbance, and multiple cranial nerve palsies. Magnetic resonance imaging revealed a multicystic mass with hemorrhagic fluid-fluid levels in the right midbrain, suggesting the presence of a cavernous malformation. Diffusion tensor imaging showed the mass to be close to the right corticospinal tract and ipsilateral medial lemniscus. Subtotal removal of the mass was performed via a right subtemporal approach. The histopathological diagnosis was of a mixed germ cell tumor (GCT) comprising mature teratoma and germinoma cells with syncytiotrophoblastic giant cells. The patient underwent postoperative chemotherapy and radiotherapy, and no tumor progression was found during 1 year of follow-up. Intracranial GCTs arise mainly in the pineal and the suprasellar area. Germ cell tumors in the brainstem are rare, with only 12 reported cases. Among these, 4 were in the midbrain and histologically were pure germinomas. To the authors' knowledge, this is the first reported case of a mixed GCT in the midbrain combining mature teratoma and germinoma cells.
Koh
Eun Jung
EJ
Division of Pediatric Neurosurgery, Seoul National University College of Medicine, Seoul, Republic of Korea.
Phi
Ji Hoon
JH
Park
Sung-Hye
SH
Kim
In-One
IO
Cheon
Jung-Eun
JE
Wang
Kyu-Chang
KC
Cho
Byung-Kyu
BK
Kim
Seung-Ki
SK
D000293:Adolescent; D020295:Brain Stem Neoplasms / Q000175:diagnosis* / Q000628:therapy*; D006801:Humans; D008297:Male; D009373:Neoplasms, Germ Cell and Embryonal / Q000175:diagnosis* / Q000628:therapy*