Abstract
We present an unusual case of a germinoma of the pineal region arising adjacent to an epidermoid cyst in a 16-year-old male. Initial imaging findings were classic for epidermoid cyst. The patient underwent two partial resections at an outside institution, each specimen demonstrating pure epidermoid cyst. Follow-up imaging over a period of 24 months showed an area of progressive contrast enhancement adjacent to the initial lesion, suggesting the development of a neoplasm. Given the area of contrast enhancement in addition to worsening headaches and visual changes, he underwent a third and final resection at our institution. Pathology revealed a mixed germ cell tumor with prominent germinoma component in addition to a well-differentiated epidermoid cyst. Details of his imaging and pathologic findings are presented, and possible explanations for these findings are explored, the most likely of which is lack of complete resection at the onset failed to identify the whole of the neoplasm. We conclude that pediatric epidermoid cysts of the pineal region should always receive close follow-up, particularly when total resection is not performed.
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References
Abramson RC, Morawetz RB, Schlitt M (1989) Multiple complications from an intracranial epidermoid cyst: case report and literature review. Neurosurgery 24(4):574–578
Edwards MS, Hudgins RJ, Wilson CB, Levin VA, Wara WM (1988) Pineal region tumors in children. J Neurosurg 68(5):689–697
Hamlat A, Hua ZF, Saikali S, Egreteau J, Guegan Y (2003) Malignant transformation of intracranial epidermoid cyst with leptomeningeal carcinomatosis: case report. Acta Neurol Belg 103(4):221–224
Hirano T, Kumabe T, Murakami K, Watanabe M, Shirane R, Yoshimoto T (2001) Metachronous neurohypophysical immature teratoma occurring 10 years after total resection of pineal mature teratoma. Childs Nerv Syst 17(4–5):286–289
Hoffman HJ, Yoshida M, Becker LE, Hendrick EB, Humphreys RP (1994) Pineal region tumors in childhood. Experience at the Hospital for Sick Children. 1983. Pediatr Neurosurg 21(1):91–103, discussion 104
Kadashev BA, Shkarubo AN, Korshunov AG, Murusidze NA, Taniashin SV (2003) [Malignant transformation of epidermoid cyst]. Zh Vopr Neirokhir Im N N Burdenko (1):38–40
Lewis AJ, Cooper PW, Kassel EE, Schwartz ML (1983) Squamous cell carcinoma arising in a suprasellar epidermoid cyst. Case report. J Neurosurg 59(3):538–541. doi:10.3171/jns.1983.59.3.0538
MacKay CI, Baeesa SS, Ventureyra EC (1999) Epidermoid cysts of the pineal region. Childs Nerv Syst 15(4):170–178
Mao Q, Ma L, Pang Z, Liu J Germinoma occurring 2 years after total resection of an intracranial epidermoid cyst in the pineal region. J Neurooncol 106 (2):437–439. doi:10.1007/s11060-011-0683-5
Russell DS RL (1977) Pathology of tumors of the nervous system. 4 edn. Williams and Wilkins
Smith AB, Rushing EJ, Smirniotopoulos JG From the archives of the AFIP: lesions of the pineal region: radiologic-pathologic correlation. Radiographics 30 (7):2001–2020. doi:30/7/2001 [pii] 10.1148/rg.307105131
Tamura K, Aoyagi M, Wakimoto H, Tamaki M, Yamamoto K, Yamamoto M, Ohno K (2006) Malignant transformation eight years after removal of a benign epidermoid cyst: a case report. J Neurooncol 79(1):67–72. doi:10.1007/s11060-005-9117-6
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The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.
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Walker, A.J., Huynh-Le, MP., Nauen, D. et al. Intracranial germinoma in the pineal region arising after subtotal resection of epidermoid cyst: case report. Childs Nerv Syst 30, 963–966 (2014). https://doi.org/10.1007/s00381-013-2317-z
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DOI: https://doi.org/10.1007/s00381-013-2317-z