Abstract
Purpose
Central nervous system germinomas often extend or disseminate into the ventricular and subarachnoid space. We present a case of primary central nervous system germinoma consisting mainly of meningeal dissemination, which is extremely unusual.
Case report
A 16-year-old boy presented with pure germinoma, manifesting as anorexia and headache for 10 days. Radiological examinations revealed a large mass lesion in the posterior fossa and a small mass lesion on the pineal lobule with thickening of the tentorium cerebelli and falx. The patient underwent partial removal of the infratentorial tumor via open surgery. Intraoperative findings indicated extension of the dural and supracerebellar mass lesions into the epiarachnoid space. Three chemotherapy courses comprising ifosfamide, etoposide, and cisplatin were administered after the surgery. Craniospinal irradiation was administered subsequently. The adjuvant therapy had a complete response.
Conclusion
Central nervous system germinoma cells may have similar compatibility to meningeal components as they do to cerebrospinal fluid or the ventricular system. If there is a possibility of the tumor extending into the subdural space during surgical intervention or other events, a range of postdiagnostic irradiation should be considered to cover a wider range.
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References
Abay EO 2nd, Laws ER Jr, Grado GL, Bruckman JE, Forbes GS, Gomez MR, Scott M (1981) Pineal tumors in children and adolescents. Treatment by CSF shunting and radiotherapy. J Neurosurg 55(6):889–895
Aida T, Abe H, Tsuru M (1983) Treatment and prognosis of primary intracranial germ cell tumors. With special reference to local recurrence and spinal metastasis. Neurol Med Chir (Tokyo) 23(6):447–455
Allen JC, Kim JH, Packer RJ (1987) Neoadjuvant chemotherapy for newly diagnosed germ-cell tumors of the central nervous system. J Neurosurg 67(1):65–70
Chen YW, Huang PI, Ho DM, Hu YW, Chang KP, Chiou SH, Guo WY, Chang FC, Liang ML, Lee YY, Chen HH, Hsu TR, Lin SC, Wong TT, Yen SH (2012) Change in treatment strategy for intracranial germinoma: long-term follow-up experience at a single institute. Cancer 118(10):2752–2762
Chen YW, Huang PI, Hu YW, Ho DM, Chang KP, Guo WY, Chang FC, Lee YY, Shiau CY, Wong TT, Yen SH (2012) Treatment strategies for initially disseminated intracranial germinomas: experiences at a single institute. Childs Nerv Syst 28(4):557–563
Cuccia V, Alderete D (2010) Suprasellar/pineal bifocal germ cell tumors. Childs Nerv Syst 26(8):1043–1049
da Silva NS, Cappellano AM, Diez B, Cavalheiro S, Gardner S, Wisoff J, Kellie S, Parker R, Garvin J, Finlay J (2010) Primary chemotherapy for intracranial germ cell tumors: results of the third international CNS germ cell tumor study. Pediatr Blood Cancer 54(3):377–383
Diez B, Balmaceda C, Matsutani M, Weiner HL (1999) Germ cell tumors of the CNS in children: recent advances in therapy. Childs Nerv Syst 15(10):578–585
Douglas-Akinwande AC, Mourad AA, Pradhan K, Hattab EM (2006) Primary intracranial germinoma presenting as a central skull base lesion. AJNR Am J Neuroradiol 27(2):270–273
Huang PI, Chen YW, Wong TT, Lee YY, Chang KP, Guo WY, Chang FC, Liang ML, Chen HH, Chiou SH, Yen SH (2008) Extended focal radiotherapy of 30 Gy alone for intracranial synchronous bifocal germinoma: a single institute experience. Childs Nerv Syst 24(11):1315–1321
Itoyama Y, Kochi M, Yamashiro S, Yoshizato K, Kuratsu J, Ushio Y (1993) Combination chemotherapy with cisplatin and etoposide for hematogenous spinal metastasis of intracranial germinoma—case report. Neurol Med Chir (Tokyo) 33(1):28–31
Kawabata Y, Takahashi JA, Arakawa Y, Shirahata M, Hashimoto N (2008) Long term outcomes in patients with intracranial germinomas: a single institution experience of irradiation with or without chemotherapy. J Neurooncol 88(2):161–167
Kim CH, Paek SH, Park IA, Chi JG, Kim DG (2002) Cerebral germinoma with hemiatrophy of the brain: report of three cases. Acta Neurochir (Wien) 144(2):145–150, discussion 150
Liang L, Korogi Y, Sugahara T, Ikushima I, Shigematsu Y, Okuda T, Takahashi M (2000) Dynamic MR imaging of neurohypophyseal germ cell tumors for differential diagnosis of infundibular diseases. Acta Radiol 41(6):562–566
Liang L, Korogi Y, Sugahara T, Ikushima I, Shigematsu Y, Okuda T, Takahashi M, Kochi M, Ushio Y (2002) MRI of intracranial germ-cell tumours. Neuroradiology 44(5):382–388
Nakajima T, Kumabe T, Jokura H, Yoshimoto T (2001) Recurrent germinoma in the optic nerve: report of two cases. Neurosurgery 48(1):214–217, discussion 217-218
Sawamura Y, Ikeda J, Shirato H, Tada M, Abe H (1998) Germ cell tumours of the central nervous system: treatment consideration based on 111 cases and their long-term clinical outcomes. Eur J Cancer 34(1):104–110
Shibamoto Y, Sasai K, Oya N, Hiraoka M (2001) Intracranial germinoma: radiation therapy with tumor volume-based dose selection. Radiology 218(2):452–456
Shikama N, Ogawa K, Tanaka S, Toita T, Nakamura K, Uno T, Ohnishi H, Itami J, Tada T, Saeki N (2005) Lack of benefit of spinal irradiation in the primary treatment of intracranial germinoma: a multiinstitutional, retrospective review of 180 patients. Cancer 104(1):126–134
Tokoro K, Chiba Y, Murase S, Yagishita S, Kyuma Y (1991) Subarachnoid dissemination of pineal germinoma 9 years after radiation therapy without local relapse—case report. Neurol Med Chir (Tokyo) 31(11):725–728
Von Rohr E, Gonner F, Schroth G, Cerny T (1999) Relapse and subarachnoid dissemination of a pineal germinoma 14 years after radiation therapy. J Clin Neurosci 6(3):247–249
Wang Y, Zou L, Gao B (2010) Intracranial germinoma: clinical and MRI findings in 56 patients. Childs Nerv Syst 26(12):1773–1777
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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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Takeshima, Y., Yamada, S., Motoyama, Y. et al. An unusual case of primary central nervous system germinoma with meningeal dissemination. Childs Nerv Syst 28, 2173–2176 (2012). https://doi.org/10.1007/s00381-012-1901-y
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DOI: https://doi.org/10.1007/s00381-012-1901-y