title: Malignant transformation of germinoma 14 years after onset: Favorable efficacy of oral etoposide.
abstract: We report the case of a 19-year-old woman with a highly malignant intracranial germ cell tumor (GCT) that developed 14 years after treatment for neurohypophyseal germinoma. Magnetic resonance imaging (MRI) showed a large neurohypophyseal mass and a synchronous lesion in the pineal region. Plasma α-fetoprotein was elevated to 3038 ng/mL. Although the tumor shrank and tumor marker levels normalized after chemotherapy and craniospinal irradiation, treatment was switched to oral etoposide for the residual tumor because of adverse events. MRI after oral etoposide introduction showed additional tumor shrinkage for 27 months after the onset of the second tumor. To the best of our knowledge, this is the longest interval between germinoma onset and the development of highly malignant recurrent GCT to be reported in the English-language literature. Oral etoposide prevented regrowth of the GCT, which has a poor prognosis, and decreased the size of the residual tumor.
authors.affiliation: Division of Pediatric Neuro-Oncology, Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, Hidaka, Japan.
authors.forename: Kohei
authors.initials: K
authors.lastname: Fukuoka
authors.affiliation: Division of Pediatric Neuro-Oncology, Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, Hidaka, Japan.
authors.forename: Takaaki
authors.initials: T
authors.lastname: Yanagisawa
authors.affiliation: Division of Pediatric Neuro-Oncology, Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, Hidaka, Japan.
authors.forename: Tomonari
authors.initials: T
authors.lastname: Suzuki
authors.affiliation: Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, Hidaka, Japan.
authors.forename: Mitsuaki
authors.initials: M
authors.lastname: Shirahata
authors.affiliation: Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, Hidaka, Japan.
authors.forename: Jun-ichi
authors.initials: J
authors.lastname: Adachi
authors.affiliation: Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, Hidaka, Japan.
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Mishima
authors.affiliation: Department of Neurosurgery, Saitama Medical University Hospital, Moroyama, Japan.
authors.forename: Takamitsu
authors.initials: T
authors.lastname: Fujimaki
authors.affiliation: Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, Hidaka, Japan.
authors.forename: Masao
authors.initials: M
authors.lastname: Matsutani
authors.affiliation: Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, Hidaka, Japan.
authors.forename: Ryo
authors.initials: R
authors.lastname: Nishikawa
mesh_terms: D000284:Administration, Oral; D000972:Antineoplastic Agents, Phytogenic / Q000008:administration & dosage; D001932:Brain Neoplasms / Q000175:diagnosis / Q000188:drug therapy*; D002471:Cell Transformation, Neoplastic; D018450:Disease Progression; D004305:Dose-Response Relationship, Drug; D005047:Etoposide / Q000008:administration & dosage*; D005260:Female; D005544:Forecasting; D018237:Germinoma / Q000175:diagnosis / Q000188:drug therapy*; D006801:Humans; D008279:Magnetic Resonance Imaging; D010904:Pituitary Gland, Posterior / Q000473:pathology*; D013997:Time Factors; D055815:Young Adult
chemical_list: D000972:Antineoplastic Agents, Phytogenic; D005047:Etoposide
keywords: germinoma; intracranial germ cell tumor; oral etoposide; yolk sac tumor