title: Germinoma recurrence in the conus medullaris 12 years after remission of primary intracranial lesion in the pituitary.
abstract: Intracranial germinomas are rare primary central nervous system tumours that are highly sensitive to radiotherapy and chemotherapy. Recurrences are infrequent, with the majority occurring within 5 years. Although multidisciplinary treatments have resulted in good event-free survival, long-term outcomes, over decades, are relatively poorly reported. We present a rare case of a recurrence in the conus medullaris 12 years after complete remission of the primary pituitary germinoma. To the best of our knowledge, this represents the first case of a significantly delayed spinal recurrence, occurring at a very distant and uncommon site, from the primary tumour. This case highlights the importance of long-term follow-up, even after complete remission, in order to identify and limit disability from late spinal recurrences in a relatively young patient population. We consider the literature regarding identifying high risk patients, and the role of craniospinal irradiation in limiting late spinal recurrences.
authors.affiliation: Department of Neurosurgery, King's College Hospital, London, UK; Department of Neurosurgery, St George's Hospital, London, UK. Electronic address: vino.siva@nhs.net.
authors.forename: Vinothan
authors.initials: V
authors.lastname: Sivasubramaniam
authors.affiliation: Department of Neurosurgery, King's College Hospital, London, UK.
authors.forename: Bassel
authors.initials: B
authors.lastname: Zebian
authors.affiliation: Department of Neurosurgery, King's College Hospital, London, UK.
authors.forename: Bhaskar
authors.initials: B
authors.lastname: Thakur
authors.affiliation: Department of Neuro-oncology and Paediatric Oncology, The Royal Marsden NHS Foundation Trust, Surrey, UK.
authors.forename: Frank
authors.initials: F
authors.lastname: Saran
authors.affiliation: Department of Neurosurgery, King's College Hospital, London, UK.
authors.forename: Christopher
authors.initials: C
authors.lastname: Chandler
mesh_terms: D018237:Germinoma / Q000556:secondary*; D006801:Humans; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D010911:Pituitary Neoplasms / Q000473:pathology*; D013116:Spinal Cord / Q000473:pathology*; D013120:Spinal Cord Neoplasms / Q000556:secondary*; D055815:Young Adult
keywords: Conus medullaris; Germinoma; Intracranial; Intramedullary; Recurrence