Abstract
Since its introduction in the neurosurgical field, neuroendoscopy has played an important role in the treatment of pineal germ cell tumors. The authors report a case of pineal germinoma revealing spontaneous regression before neuroendoscopic surgery. A 15-year-old boy presented with chronic headache, deterioration of his visual acuity, and diplopia. Head magnetic resonance imaging (MRI) revealed a large tumor in the pineal region and triventricular hydrocephalus due to occlusion of the aqueduct. As levels of tumor markers in serum and cerebrospinal fluid, including those of alpha-fetoprotein, carcinoembryonic antigen, human chorionic gonadotropin (hCG), and the beta-subunit of hCG, were all within the normal ranges, endoscopic surgery for biopsy and third ventriculocisternostomy was performed. Under endoscopic view, the tumor was revealed to be smaller than expected from preoperative images. MRI obtained 14 days after admission disclosed marked shrinkage of the tumor. The histopathological diagnosis was pure germinoma, and the patient underwent chemotherapy combined with fractionated radiotherapy. The tumor disappeared, and the patient did not show any signs of relapse. Spontaneous regression is a very rare phenomenon in malignant brain tumors, and in the literature it has been uncommonly described in pineal germ cell tumors. Our case disclosed a pitfall of modern strategy for this pathology with neuroendoscopy. Dilated ventricles and a certain amount of lesion are factors for safe endoscopic biopsy of pineal tumors. Radiographic images shortly before surgery are warranted, especially in patients whose symptoms of intracranial hypertension have already improved before surgery.
References
Fèvre-Montange M, Vasiljevic A, Champier J, Jouvet A (2010) Histopathology of tumors of the pineal region. Future Oncol 6:791–809
Edwards MS, Hudgins RJ, Wilson CB, Levin VA, Wara WM (1988) Pineal region tumors in children. J Neurosurg 68:689–697
Jooma R, Kendall BE (1983) Diagnosis and management of pineal tumors. J Neurosurg 58:654–665
Oi S, Matsumoto S (1992) Controversy pertaining to therapeutic modalities for tumors of the pineal region: a worldwide survey of different patient populations. Childs Nerv Syst 8:332–336
Chernov MF, Kamikawa S, Yamane F, Ishihara S, Kubo O, Hori T (2006) Neurofiberscopic biopsy of tumors of the pineal region and posterior third ventricle: indications, technique, complications, and results. Neurosurgery 59:267–277
Gangemi M, Maiuri F, Colella G, Buonamassa S (2001) Endoscopic surgery for pineal region tumors. Minim Invasive Neurosurg 44:70–73
Robinson S, Cohen AR (1997) The role of neuroendoscopy in the treatment of pineal region tumors. Surg Neurol 48:360–367
Matsutani M, Japanese Pediatric Brain Tumor Study Group (2001) Combined chemotherapy and radiation therapy for CNS germ cell tumors—the Japanese experience. J Neurooncol 54:311–316
Cole WH (1981) Efforts to explain spontaneous regression of cancer. J Surg Oncol 17:201–209
Fujimaki T, Mishima K, Asai A, Suzuki I, Kirino T (1999) Spontaneous regression of a residual pineal tumor after resection of a cerebellar vermian germinoma. J Neurooncol 41:65–70
Ide M, Jimbo M, Yamamoto M, Hagiwara S, Aiba M, Kubo O (1997) Spontaneous regression of primary intracranial germinoma. A case report. Cancer 79:558–563
Murai Y, Kobayashi S, Mizunari T, Ohaki Y, Adachi K, Teramoto A (2000) Spontaneous regression of a germinoma in the pineal body after placement of a ventriculoperitoneal shunt. J Neurosurg 93:884–886
van Aalst J, Beuls EA, van Nie FA, Vles JS, Cornips EM (2002) Acute distortion of the anatomy of the third ventricular during third ventriculostomy. Report of four cases. J Neurosurg 96:597–599
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Ono, H., Shin, M., Takai, K. et al. Spontaneous regression of germinoma in the pineal region before endoscopic surgery: a pitfall of modern strategy for pineal germ cell tumors. J Neurooncol 103, 755–758 (2011). https://doi.org/10.1007/s11060-010-0432-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11060-010-0432-1