Pineal mixed germ cell tumor with a synchronous sellar lesion in the sixth decade

Brain Tumor Pathol. 2011 Apr;28(2):163-6. doi: 10.1007/s10014-011-0018-4. Epub 2011 Feb 2.

Abstract

Intracranial germ cell tumors (GCTs) typically affect children and adolescents. We here report on a 59-year-old male patient presenting with diplopia, polydipsia and polyuria. On clinical examination, slight restriction of the upward gaze was seen on the left side. Computed tomography demonstrated calcifications in the pineal region and enhanced neurohypophysis. Magnetic resonance imaging displayed a heterogeneous pineal mass of 3-cm diameter, which was multicystic with an enhanced cyst wall, and also swelling of the pituitary stalk. The pineal lesion of the tumor, which included calcifications and keratinaceous components, was totally excised using an occipital transtentorial approach. Histopathological examination showed it to be a mixed GCT with germinoma and mature teratoma components. Postoperative chemoradiotherapy provided complete disappearance of the suprasellar lesion. To our knowledge, this is the first case of mixed bifocal GCT in an older adult reported in the literature, although a few cases of tumors with a single histological component have been reported. Hence, our case further underlines the possibility of the occurrence of GCTs in older adults and advocates the consideration of GCTs in the differential diagnosis of such cases for appropriate management.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Brain Neoplasms* / diagnosis
  • Brain Neoplasms* / metabolism
  • Brain Neoplasms* / pathology
  • Brain Neoplasms* / surgery
  • Calcinosis / pathology
  • Carcinoembryonic Antigen / blood
  • Carcinoembryonic Antigen / cerebrospinal fluid
  • Chorionic Gonadotropin, beta Subunit, Human / blood
  • Chorionic Gonadotropin, beta Subunit, Human / cerebrospinal fluid
  • Germinoma / diagnosis
  • Germinoma / metabolism
  • Germinoma / pathology*
  • Germinoma / surgery
  • Humans
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Neoplasms, Multiple Primary / diagnosis
  • Neoplasms, Multiple Primary / metabolism
  • Neoplasms, Multiple Primary / pathology
  • Neoplasms, Multiple Primary / surgery
  • Pineal Gland / pathology*
  • Pinealoma / pathology
  • Teratoma / diagnosis
  • Teratoma / metabolism
  • Teratoma / pathology*
  • Teratoma / surgery
  • alpha-Fetoproteins / cerebrospinal fluid

Substances

  • Carcinoembryonic Antigen
  • Chorionic Gonadotropin, beta Subunit, Human
  • alpha-Fetoproteins