Brain Tumor Res Treat.  2016 Apr;4(1):21-25. 10.14791/btrt.2016.4.1.21.

A Case of Nongerminomatous Germ Cell Tumor with Fulminant Course Concomitant Leptomeningeal Metastasis

• Jeong YB
• Wang KC
• Phi JH
• Lee JY
• Cheon JE
• Kang HJ
• Kim IH
• Kim SK

• KMID: 2165230
• DOI: http://doi.org/10.14791/btrt.2016.4.1.21

Abstract

We present the case of a 9-year-old boy with a non-germinomatous germ cell tumor (NGGCT) in the pineal gland that exhibited a fulminant course following chemo- and radiotherapy. After the detection of the tiny cerebellar enhancing nodule at the end of chemo- and radiotherapy, tumor seeding progressed rapidly into the entire cisternal space. We herein report a rare case of NGGCT with fulminant clinical course of concomitant cerebellar seeding, with review of literature.

Keyword

Germ cell tumor; Pinealoma; Neoplasm metastasis; Cerebellar neoplasm; Cerebrospinal fluid; Tumor markers

MeSH Terms

Cerebellar Neoplasms
Cerebrospinal Fluid
Child
Germ Cells*
Humans
Male
Neoplasm Metastasis*
Neoplasms, Germ Cell and Embryonal*
Pineal Gland
Pinealoma
Radiotherapy
Biomarkers, Tumor
Tumor Markers, Biological

Figure

• 

  Fig. 1 Initial images. MR image showing the pineal mass, which is hypointense on T1- (A) and hyperintense on T2-weighted images (B). The mass is strongly enhanced following the injection of gadolinium (C: axial, D: sagittal image).

• 

  Fig. 2 Post-therapy images. Midsagittal T1-weighted MR image with gadolinium enhancement after chemotherapy (A) and radiotherapy (B). A tiny enhancing nodule (arrow) appears in the right paramedian cerebellar tonsil.

• 

  Fig. 3 Navigation images. Navigation MR image revealing an enlarged cerebellar nodule (A) with massive leptomeningeal seeding that includes the prepontine, sylvian and suprasellar cisterns (B).

• 

  Fig. 4 Terminal state images. Two and one-half months after the navigation image, a T1-weighted MR image with gadolinium enhancement showing extensive cerebrospinal fluid seeding into the entire cisternal space (A) and entire spinal axis (B).

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