title: Intratumoral hemorrhage because of primary spinal mixed germ cell tumor presenting with atypical radiological features in an adult.
abstract: BACKGROUND
  Germ cell tumors are known to arise in the central nervous system, usually in the intracranial regions. However, primary spinal mixed germ cell tumors are extremely rare.
  
  
  OBJECTIVE
  This is the first reported case of intratumoral hemorrhage because of a primary spinal mixed germ cell tumor consisting of germinoma and immature teratoma in the conus medullaris of an adult patient that presented with rapid changes on magnetic resonance image (MRI). We report this rare case and discuss the clinical manifestations of an intramedullary spinal mixed germ cell tumor in adult.
  
  
  METHODS
  A case report.
  
  
  METHODS
  A 42-year-old woman experienced buttock numbness, and a spinal cord tumor was observed on the conus medullaris on MRI. The patient was scheduled for an operation in 1 month, but she developed sudden-onset neurologic deterioration. Rapid progression of the tumor was observed on follow-up MRI. The tumor was removed by emergency surgery and was identified as a primary mixed germinoma and immature teratoma.
  
  
  RESULTS
  The patient received adjuvant chemotherapy and radiotherapy after gross total resection. The neurologic deficit of the patient was relieved, and recurrence of the tumor was not observed 26 months after the surgery.
  
  
  CONCLUSIONS
  We present this rare case and emphasize the necessity of precise diagnosis and early treatment of primary spinal germ cell tumor. Close observation on MRI is required after surgery, and adjuvant chemotherapy and radiotherapy should be considered according to the pathologic features.
authors: Department of Neurosurgery, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu 807-8555, Japan. Electronic address: yama9218@med.uoeh-u.ac.jp.
authors: Junkoh
authors: J
authors: Yamamoto
authors: Mayu
authors: M
authors: Takahashi
authors: Yoshiteru
authors: Y
authors: Nakano
authors: Takeshi
authors: T
authors: Saito
authors: Takehiro
authors: T
authors: Kitagawa
authors: Kunihiro
authors: K
authors: Ueta
authors: Ryo
authors: R
authors: Miyaoka
authors: Eiichiro
authors: E
authors: Nakamura
authors: Shigeru
authors: S
authors: Nishizawa
mesh_terms: D000328:Adult; D002420:Cauda Equina / Q000473:pathology; D059248:Chemoradiotherapy; D019299:Decompression, Surgical; D005260:Female; D006470:Hemorrhage / Q000209:etiology / Q000473:pathology; D006801:Humans; D008279:Magnetic Resonance Imaging; D009373:Neoplasms, Germ Cell and Embryonal / Q000150:complications / Q000473:pathology* / Q000628:therapy; D013120:Spinal Cord Neoplasms / Q000150:complications / Q000473:pathology* / Q000628:therapy
keywords: Germinoma; Immature; Intratumoral hemorrhage; Spinal cord tumor; Teratoma