title: Pineal mixed germ cell tumor with a synchronous sellar lesion in the sixth decade.
abstract: Intracranial germ cell tumors (GCTs) typically affect children and adolescents. We here report on a 59-year-old male patient presenting with diplopia, polydipsia and polyuria. On clinical examination, slight restriction of the upward gaze was seen on the left side. Computed tomography demonstrated calcifications in the pineal region and enhanced neurohypophysis. Magnetic resonance imaging displayed a heterogeneous pineal mass of 3-cm diameter, which was multicystic with an enhanced cyst wall, and also swelling of the pituitary stalk. The pineal lesion of the tumor, which included calcifications and keratinaceous components, was totally excised using an occipital transtentorial approach. Histopathological examination showed it to be a mixed GCT with germinoma and mature teratoma components. Postoperative chemoradiotherapy provided complete disappearance of the suprasellar lesion. To our knowledge, this is the first case of mixed bifocal GCT in an older adult reported in the literature, although a few cases of tumors with a single histological component have been reported. Hence, our case further underlines the possibility of the occurrence of GCTs in older adults and advocates the consideration of GCTs in the differential diagnosis of such cases for appropriate management.
authors.affiliation: Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan.
authors.forename: Manoj
authors.initials: M
authors.lastname: Bohara
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Hirano
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Tokimura
authors.forename: Ryosuke
authors.initials: R
authors.lastname: Hanaya
authors.forename: Hajime
authors.initials: H
authors.lastname: Yonezawa
authors.forename: Francia
authors.initials: F
authors.lastname: Campos
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Sugiyama
authors.forename: Sei
authors.initials: S
authors.lastname: Sugata
authors.forename: Kazunori
authors.initials: K
authors.lastname: Arita
mesh_terms: D001932:Brain Neoplasms / Q000175:diagnosis / Q000378:metabolism / Q000473:pathology / Q000601:surgery; D002114:Calcinosis / Q000473:pathology; D002272:Carcinoembryonic Antigen / Q000097:blood / Q000134:cerebrospinal fluid; D018997:Chorionic Gonadotropin, beta Subunit, Human / Q000097:blood / Q000134:cerebrospinal fluid; D018237:Germinoma / Q000175:diagnosis / Q000378:metabolism / Q000473:pathology* / Q000601:surgery; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009378:Neoplasms, Multiple Primary / Q000175:diagnosis / Q000378:metabolism / Q000473:pathology / Q000601:surgery; D010870:Pineal Gland / Q000473:pathology*; D010871:Pinealoma / Q000473:pathology; D013724:Teratoma / Q000175:diagnosis / Q000378:metabolism / Q000473:pathology* / Q000601:surgery; D000509:alpha-Fetoproteins / Q000134:cerebrospinal fluid
chemical_list: D002272:Carcinoembryonic Antigen; D018997:Chorionic Gonadotropin, beta Subunit, Human; D000509:alpha-Fetoproteins