Abstract
Extraneural metastases of intracranial germinomas, although infrequent, are associated with a generally poor prognosis despite the high radiosensitivity of localized primary tumors. Ventriculoperitoneal shunts have been implicated in facilitating metastatic spread of primary intracranial germinomas. We present a case of a successfully irradiated suprasellar germinoma recurring after 13 months as an intra-abdominal yolk-sac tumor in a young man. The tumor was eradicated with a combination of systemic chemotherapy and local irradiation, with no residual viable tumor cells confirmed at final surgical extirpation. The role of cerebrospinal fluid (CSF) shunts in metastases, mixed germ-cell tumor histology, and tumor markers in recurrences as well as radiation doses and volumes for treating primary tumors are discussed. Systemic chemotherapy may be utilized as prophylaxis against shunt metastases when CSF drainage is necessary.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Ono N, Isobe I, Uki J, et al (1994) Recurrence of primary intracranial germinomas after complete response with radiotherapy: recurrence patterns and therapy. Neurosurgery 35: 615–621
Neuwelt EA, Glasberg M, Frenkel E, et al (1979) Malignant pineal region tumors: a clinico-pathological study. J Neurosurg 51: 597–607
Kun LE, Tang TT, Sty JR, et al (1981) Primary cerebral germinoma and ventriculoperitoneal shunt metastasis. Cancer 48: 213–216
Haimovic IC, Sharer L, Hyman RA, et al (1981) Metastasis of intracranial germinoma through a ventriculoperitoneal shunt. Cancer 48: 1033–1036
Edwards MSB, Hudgins RJ, Wilson CB (1988) Pineal region tumors in children. J Neurosurg 68: 689–696
Hoffman HJ, Otsubo H, Hendrick EB, et al (1991) Intracranial germ cell tumors in children. J Neurosurg 74: 545–551
Jenkin D, Berry M, Chan H, et al (1990) Pineal region germinomas in childhood: treatment considerations. Int J Radiat Oncol Biol Phys 18: 541–545
Hoffman HJ, Duffner PK (1985) Extraneural metastases of central nervous system tumors. Cancer 56: 1778–1784
Hoffman HJ, Hendrick EB, Humphreys RP (1976) Metastasis via ventriculoperitoneal shunt in patients with medulloblastoma. J Neurosurg 44: 562–566
Hoffman-Giles R, Besser M, Johnston IH, et al (1984) Disseminated hematogenous metastases from a pineal germinoma in an infant. J Neurosurg 60: 835–837
Gay JC, Janco RL, Lukens JN (1985) Systemic metastases in primary intracranial germinoma. Cancer 55: 2688–2690
Berger MS, Baumeister B, Geyer JR, et al (1991) The risks of metastases from shunting in children with primary central nervous system tumors. J Neurosurg 74: 872
Edwards MSB, Baumgartner JE (1994) Pineal region tumors. In: Cheek JA (ed) Pediatric nemosurgery, 3rd edn. W. B. Saunders, Philadelphia, pp 429–436
Stein BM (1979) Surgical treatment of pineal tumors. Clin Neurosurg 26: 490–495
Damjanov I (1989) Is seminoma a relative or a precursor of embryonal carcinoma? Lab Invest 60: 1–3
Pizzo PA, Horowitz ME, Poplack DG, et al (1993) Solid tumors of childhood: germ cell tumors. In: DeVita VT, Hellman S, Rosenberg SA (eds) Cancer: principles and practice of oncology, 4th edn. Lippincott, Philadelphia, pp 1765–1771
Salazar OM, Castro-Vita H, Bakos RS, et al (1979) Radiation therapy for tumors of the pineal region. Int J Radiat Oncol Biol Phys 5: 491–496
Edwards MSB, Levin VA (1987) Chemotherapy of third ventricle tumors. In: Appuzzo M (ed) Third ventricular tumors. Williams and Wilkins, Baltimore, pp 838–845
Levin VA, Gutin PH, Leibel S (1993) Neoplasms of the central nervous system: pineal region tumors. In: DeVita VT, Hellman S, Rosenberg SA (eds) Cancer: principles and practice of oncology, 4th edn. Lippincott, Philadelphia, pp 1720–1722
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Back, M.R., Hu, B., Rutgers, J. et al. Metastasis of an intracranial germinoma through a ventriculoperitoneal shunt: Recurrence as a yolk-sac tumor. Pediatr Surg Int 12, 24–27 (1997). https://doi.org/10.1007/BF01194796
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/BF01194796