Diffuse peritoneal dissemination of intracranial pure germinoma via ventriculoperitoneal shunt

Abstract

Germinomas frequently cause hydrocephalus, and ventriculoperitoneal shunts (VPS) have been commonly used for their management. Although VPS can potentially serve as a route for peritoneal dissemination of germinomas, the abdominal imaging characteristics of this rare yet important complication remain unknown. In this article, we report the computed tomography imaging findings of diffuse peritoneal dissemination of intracranial germinoma.

Keywords: Computed tomography; Germinoma; Magnetic resonance imaging; Peritoneal dissemination; Ventriculoperitoneal shunt.

Fig. 1

Intracranial pure germinoma and diffuse peritoneal dissemination. A, B: Nonenhanced CT and T2-weighted sagittal image of the primary pineal pure germinoma 20 years ago. There is a high-attenuated and hyperintense mass with multiple cystic components in the pineal region (A, B, arrows). C: Fat-suppressed 3-dimentional contrast-enhanced T1-weighted imaging of the brain shows a recurrent tumor with contrast enhancement in the right frontal horn (arrow) adjacent to the tip of the VPS (white arrowhead). D–G: Contrast-enhanced abdominal CT images (D–F: axial imaging, G: coronal imaging) show the VPS (white arrowheads) and diffuse confluent multinodular masses with homogeneous enhancement with approximately 70 Hounsfield Unit, except for the suspected central necrosis in the largest omental mass, along the abdominal wall and greater omentum (black arrowheads). Massive ascites with approximately 20 Hounsfield Unit are also demonstrated

Fig. 2

Autopsy pathology of the omental tumor (A, B), cell block specimen obtained from the VPS (C), and intracranial periventricular tumor (D–F). (A) HE stain (× 40) and (B) (× 100) showing diffuse proliferation of tumor cells with enlarged round to oval nuclei and clear to eosinophilic cytoplasm. (C) HE stain (× 400) reveals similar tumor cells (arrows) admixed with mesothelial cells (arrowheads) in the cell block specimen obtained from the VPS. (D) HE stain (× 100) shows similar tumor cells positive for D2-40 (E, × 200) and negative for calretinin (F, × 100). The tumor cells were histologically similar to those of the previously diagnosed pineal pure germinoma (not shown)