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Vasospasm and subsequent stroke from paraneoplastic syndrome in a pediatric patient with an intracranial mature teratoma: a case report

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Abstract

Teratomas account for 18–20% of all intracranial germ cell tumors and mostly occur in the pineal region with only a few cases of pediatric sellar and suprasellar teratomas described in the literature. Here, we present a case of a child with an intracranial mature teratoma with pancreatic features causing vasospasm and subsequent stroke, found to be positive for CDKN2A—an independent variant associated with malignancy and small vessel disease leading to stroke.

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Abbreviations

MRI:

Magnetic Resonance Imaging

DWI:

Diffusion Weighted Imaging

MCA:

Middle cerebral artery

ACA:

Anterior cerebral artery

ICA:

Internal carotid artery

References

  1. Noudel R et al (2008) Intracranial teratomas in children: the role and timing of surgical removal. J Neurosurg Pediatr 2(5):331–338

    Article  PubMed  Google Scholar 

  2. Fults D, Kelly DL Jr (1983) A suprasellar atypical teratoma presenting as an intrasellar mass: a case report. Neurosurgery 13(1):40–43

    Article  CAS  PubMed  Google Scholar 

  3. Kürner K et al (2021) Pediatric sellar teratoma — case report and review of the literature. Childs Nerv Syst

  4. Tsoukalas N et al (2013) Coexistence of intracranial germ cell tumor and craniopharyngioma in an adolescent: case report and review of the literature. Int J Clin Exp Med 6(3):211–218

    PubMed  PubMed Central  Google Scholar 

  5. Lee YJ et al (1995) Loss of visibility of the neurohypophysis as a sign of central diabetes insipidus. Eur J Radiol 21(2):145–147

    Article  CAS  PubMed  Google Scholar 

  6. Cho DY, Wang YC, Ho WL (1997) Primary intrasellar mixed germ-cell tumor with precocious puberty and diabetes insipidus. Childs Nerv Syst 13(1):42–46

    Article  CAS  PubMed  Google Scholar 

  7. Ikeda J et al (1998) Metachronous neurohypophyseal germinoma occurring 8 years after total resection of pineal mature teratoma. Surg Neurol 49(2):205–8,discussion 208–9

    Article  CAS  PubMed  Google Scholar 

  8. Yagi K et al (2004) Growing teratoma syndrome in a patient with a non-germinomatous germ cell tumor in the neurohypophysis–case report. Neurol Med Chir (Tokyo) 44(1):33–37

    Article  PubMed  Google Scholar 

  9. Chang CV et al (2008) Mixed germ cell tumor of the pituitary-hypothalamic region presenting as craniopharyngioma: case report and review of the literature. Arq Bras Endocrinol Metabol 52(9):1501–1504

    Article  PubMed  Google Scholar 

  10. Vendrell JF, Hoa D, Gahide G (2010) Mature teratoma arising from the sella. Lancet 375(9725):1556

    Article  PubMed  Google Scholar 

  11. Kim YS, Kang SG, Kim YO (2010) Pituitary teratoma presenting as central diabetes insipidus with a normal MRI finding. Yonsei Med J 51(2):293–294

    Article  PubMed  PubMed Central  Google Scholar 

  12. Chiloiro S, Giampietro A, De Marinis L (2015) Safety of rhGH replacement therapy in suprasellar pituitary teratoma a case-report. Int J Endocr Metab Disord 1(2)

  13. Yoneoka Y et al (2018) Third ventricle germ cell tumor originating from the infundibulum with rapidly expansive enlargement. Pediatr Neurosurg 53(1):49–54

    Article  PubMed  Google Scholar 

  14. Araki K et al (2000) A boy with normal growth in spite of growth hormone deficiency after resection of a suprasellar teratoma. Endocr J 47(Suppl):S101–S104

    Article  PubMed  Google Scholar 

  15. Wahlstrand B et al (2009) The myocardial infarction associated CDKN2A/CDKN2B locus on chromosome 9p21 is associated with stroke independently of coronary events in patients with hypertension. J Hypertens 27(4):769–773

    Article  CAS  PubMed  Google Scholar 

  16. Zimmerman RA et al (1980) Computed tomography of pineal, parapineal, and histologically related tumors. Radiology 137(3):669–677

    Article  CAS  PubMed  Google Scholar 

  17. Murray MJ et al (2015) Consensus on the management of intracranial germ-cell tumours. Lancet Oncol 16(9):e470–e477

    Article  PubMed  Google Scholar 

  18. Aoyama H et al (1998) Retrospective multi-institutional study of radiotherapy for intracranial non-germinomatous germ cell tumors. Radiother Oncol 49(1):55–59

    Article  CAS  PubMed  Google Scholar 

  19. Hoffman HJ et al (1991) Intracranial germ-cell tumors in children. J Neurosurg 74(4):545–551

    Article  CAS  PubMed  Google Scholar 

  20. Richards S et al (2015) Standards and guidelines for the interpretation of sequence variants: a joint consensus recommendation of the American College of Medical Genetics and Genomics and the Association for Molecular Pathology. Genet Med 17(5):405–424

    Article  PubMed  PubMed Central  Google Scholar 

  21. Miller DT et al (2021) ACMG SF v3.0 list for reporting of secondary findings in clinical exome and genome sequencing a policy statement of the American College of Medical Genetics and Genomics (ACMG). Genet Med 23(8):1381–1390

    Article  PubMed  Google Scholar 

  22. Harinck F et al (2012) Indication for CDKN2A-mutation analysis in familial pancreatic cancer families without melanomas. J Med Genet 49(6):362–365

    Article  CAS  PubMed  Google Scholar 

  23. Soufir N et al (1998) Prevalence of p16 and CDK4 germline mutations in 48 melanoma-prone families in France The French Familial Melanoma Study Group. Hum Mol Genet 7(2):209–16

    Article  CAS  PubMed  Google Scholar 

  24. Park JE, Liang TW (2014) Reversible cerebellar ataxia due to ovarian teratoma. J Clin Neurosci 21(8):1467–1469

    Article  PubMed  Google Scholar 

  25. Jagtap SA et al (2022) Ruptured cerebellopontine angle dermoid cyst presenting as young stroke. Neurol India 70(5):2241–2242

    Article  PubMed  Google Scholar 

  26. Jin H et al (2017) Intracranial dermoid cyst rupture-related brain ischemia: case report and hemodynamic study. Medicine (Baltimore) 96(4):e5631

    Article  PubMed  Google Scholar 

  27. Kang MG et al (2009) Intracranial dermoid cyst rupture with midbrain and thalamic infarction. Neurology 72(8):769

    Article  PubMed  Google Scholar 

  28. Civit T et al (1997) Stroke related to a dermoid cyst: case report. Neurosurgery 41(6):1396–1399

    Article  CAS  PubMed  Google Scholar 

  29. Zheng K et al (2010) Ruptured intracranial dermoid cyst with infarction in the basal ganglia—case report. Neurol Med Chir (Tokyo) 50(3):254–256

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Division of Pediatric Neurosurgery, Johns Hopkins All Children’s Hospital, St Petersburg, FL, USA

    Amanda V. Jenson, Sara Hartnett-Wright, S. Hassan A. Akbari & Matthew D. Smyth

  2. School of Public Health, University of Michigan, Ann Arbor, MI, USA

    Ali Yunus Rizvi

  3. Division of Pediatric Neurosurgery, University of Iowa Stead Family Children’s Hospital, Iowa City, IA, USA

    Rebecca A. Reynolds

  4. Division of Pediatric Neurology, Johns Hopkins All Children’s Hospital, St Petersburg, FL, USA

    Thomas J. Gellar

  5. Division of Pediatric Oncology, Johns Hopkins All Children’s Hospital, St Petersburg, FL, USA

    Stacie Stapleton

  6. Division of Pediatric Pathology, Johns Hopkins All Children’s Hospital, St Petersburg, FL, USA

    Ignacio Gonzalez-Gomez

Authors
  1. Amanda V. Jenson
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  2. Ali Yunus Rizvi
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  3. Rebecca A. Reynolds
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  4. Sara Hartnett-Wright
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  5. Thomas J. Gellar
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  6. Stacie Stapleton
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  7. Ignacio Gonzalez-Gomez
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  8. S. Hassan A. Akbari
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  9. Matthew D. Smyth
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Contributions

Dr. AJ: the neurosurgery fellow on the case and who wrote the manuscript. AYR: a medical school candidate who helped with the write up and images. Dr. RR: the previous pediatric neurosurgery fellow who operated on and cared for this patient Dr. SHW and Dr. SHA: who both cared for the patient and helped with the write up, literature review and editing. Dr. TJ: the neurologist who made the connection of the CDKN2A gene defect and higher risk of stroke. Dr. SS: the oncologist who cared for the patient. Dr. IGG: the pathologist who diagnosed the mature teratoma and pancreatic features. Dr. MDS: who was the primary surgeon on the case.

Corresponding author

Correspondence to Amanda V. Jenson.

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Jenson, A.V., Rizvi, A.Y., Reynolds, R.A. et al. Vasospasm and subsequent stroke from paraneoplastic syndrome in a pediatric patient with an intracranial mature teratoma: a case report. Childs Nerv Syst (2024). https://doi.org/10.1007/s00381-024-06471-z

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  • DOI: https://doi.org/10.1007/s00381-024-06471-z

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