title: Intramedullary recurrence of germinoma in the spinal cord 15 years after complete remission of a pineal lesion.
abstract: The authors present a case of germinoma that was initially found in the pineal region and recurred 15 years later in the intramedullary cervical spinal cord after intensive chemo- and radiotherapy and diagnosis of complete remission.   This 28-year-old man initially presented with seizures. Hydrocephalus and a pineal tumor were found on radiological examination, and partial resection of the tumor was performed. Histological diagnosis showed a pure germinoma. Following surgery, the patient received a combination of chemo- and radiotherapy, and a complete remission was shown. However, after 15 years of follow-up, he presented with gait disturbances. Spinal MRI showed an intramedullary mass lesion in the cervical spinal cord. The cervical lesion was biopsied, and histological examination again revealed a pure germinoma.   With germinomas, the possibility of a drop metastasis from an intracranial lesion to the spinal cord must be considered during follow-up. However, in the present case, analysis of a CSF sample showed no abnormalities as in previously published cases. In recent years, multidisciplinary treatments have demonstrated good event-free survival rates in cases of pure germinomas, but long-term outcomes over the decades are not fully known. Continual follow-up of such cases is recommended even after complete remission has been achieved.
authors.affiliation: Department of Neurosurgery, University of Tokyo Hospital, Tokyo, Japan. hanakita-s@umin.ac.jp
authors.forename: Shunya
authors.initials: S
authors.lastname: Hanakita
authors.forename: Atumi
authors.initials: A
authors.lastname: Takenobu
authors.forename: Atsushi
authors.initials: A
authors.lastname: Kambe
authors.forename: Takashi
authors.initials: T
authors.lastname: Watanabe
authors.forename: Masahiro
authors.initials: M
authors.lastname: Shin
authors.forename: Akira
authors.initials: A
authors.lastname: Teraoka
mesh_terms: D000328:Adult; D001932:Brain Neoplasms / Q000473:pathology* / Q000628:therapy; D018237:Germinoma / Q000556:secondary* / Q000628:therapy*; D006801:Humans; D008297:Male; D010870:Pineal Gland; D013120:Spinal Cord Neoplasms / Q000556:secondary* / Q000628:therapy*; D013997:Time Factors