title: Successful treatment of metastatic βHCG-secreting germ cell tumor occurring 3 years after total resection of a pineal mature teratoma.
abstract: Patients diagnosed with intracranial teratoma are at risk for developing a recurrent malignant germ cell tumor. We describe a 14-year-old boy initially diagnosed with a mature teratoma in the pineal region that recurred as a metastatic beta-human chorionic gonadotropin (βHCG)-secreting germ cell tumor 3 years after gross total resection. A surveillance brain MRI scan during follow-up demonstrated multiple lesions within the ventricular and subependymal area infiltrating the brain parenchyma along with concomitant elevated levels of βHCG in both the serum and cerebrospinal fluid. The patient underwent chemotherapy with PEI (cis-platinum, etoposide, ifosfamide) followed by radiation therapy according to the SIOP CNS GCT protocol. The patient is currently alive without evidence of disease 35 months after starting therapy.
  
  
  CONCLUSIONS
  A careful and long-term follow-up including scheduled tumor markers as well as surveillance MRI scans is required for patients with intracranial teratoma in an effort to detect and diagnose recurrent malignant disease, especially since multimodal therapy provides the potential for long-term cure.
authors.affiliation: Neuro-Oncology Unit, Department of Paediatric Medicine, Meyer Children's University Hospital, viale G. Pieraccini 24, 50139, Florence, Italy.
authors.forename: Stefania
authors.initials: S
authors.lastname: Cardellicchio
authors.forename: Silvia
authors.initials: S
authors.lastname: Farina
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: Buccoliero
authors.forename: Benedetta
authors.initials: B
authors.lastname: Agresti
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Genitori
authors.forename: Maurizio
authors.initials: M
authors.lastname: de Martino
authors.forename: Jason
authors.initials: J
authors.lastname: Fangusaro
authors.forename: Iacopo
authors.initials: I
authors.lastname: Sardi
mesh_terms: D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D018997:Chorionic Gonadotropin, beta Subunit, Human / Q000097:blood* / Q000134:cerebrospinal fluid; D002945:Cisplatin / Q000627:therapeutic use; D003131:Combined Modality Therapy; D005047:Etoposide / Q000627:therapeutic use; D006801:Humans; D007069:Ifosfamide / Q000627:therapeutic use; D008279:Magnetic Resonance Imaging; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000188:drug therapy; D010871:Pinealoma / Q000097:blood / Q000175:diagnosis* / Q000601:surgery* / Q000628:therapy; D018714:Radiotherapy, Adjuvant; D013724:Teratoma / Q000097:blood / Q000175:diagnosis* / Q000601:surgery* / Q000628:therapy; D016896:Treatment Outcome
chemical_list: D018997:Chorionic Gonadotropin, beta Subunit, Human; D005047:Etoposide; D002945:Cisplatin; D007069:Ifosfamide