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Case Reports
. 2018 Mar 11:2018:5106701.
doi: 10.1155/2018/5106701. eCollection 2018.

A Case of Nongerminomatous Germ Cell Tumor of the Pineal Region: Risks and Advantages of Biopsy by Endoscopic Approach

Mauro Dobran  1 , Davide Nasi  1 , Fabrizio Mancini  1 , Maurizio Gladi  1 , Massimo Scerrati  1
Affiliations
Case Reports

A Case of Nongerminomatous Germ Cell Tumor of the Pineal Region: Risks and Advantages of Biopsy by Endoscopic Approach

Mauro Dobran et al. Case Rep Med. .

Abstract

A 21-year-old male was admitted to our department with headache and drowsiness. CT scan and MRI revealed acute obstructive hydrocephalus caused by a pineal region mass. The serum and CSF levels of beta-human chorionic gonadotropin (beta-hCG) were 215 IU/L and 447 IU/L, respectively, while levels of alpha-fetoprotein (AFP) were normal. A germ cell tumor (GCT) was suspected, and the patient underwent endoscopic third ventriculostomy (ETV) with biopsy. After four days from surgery, the tumor bled with mass expansion and ETV stoma occlusion; thus, a ventriculoperitoneal shunt was positioned. After ten months, the tumor metastasized to the thorax and abdomen with progression of intracerebral tumor mass. Despite the aggressive nature of this tumor, ETV remains a valid approach for a pineal region mass, but in case of GCT, the risk of bleeding should be taken into account, during and after the surgical procedure.

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Figures

Figure 1
Figure 1
CT scan and MRI at admission documented acute obstructive hydrocephalus caused by a pineal region mass.
Figure 2
Figure 2
Acute obstructive hydrocephalus 24 hours after EVD closure.
Figure 3
Figure 3
Intratumoral hemorrhage with mass expansion and complete occlusion of the third ventricle.
Figure 4
Figure 4
MRI after chemotherapy shows residual tumor mass. For this lesion, the patient underwent stereotactic radiosurgery.
Figure 5
Figure 5
CT scan showing the new cerebral focal lesion.
Figure 6
Figure 6
CT scan of the thorax and abdomen showing the lung (green arrow), liver (red arrow), and left adrenal (blue arrow) lesions.
Figure 7
Figure 7
Endoscopic third ventriculostomy procedure. (a) Anterior view of the tumor. (b) Subependymal spread. (c) Stoma. (d) Stoma with basilar artery view.
See this image and copyright information in PMC

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