An unusual case of primary central nervous system germinoma with meningeal dissemination.
An unusual case of primary central nervous system germinoma with meningeal dissemination.
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原发性中枢神经系统生殖细胞瘤伴脑膜播散的罕见病例。
DOI：
10.1007/s00381-012-1901-y
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发表时间：
2012
期刊：
影响因子：
--
通讯作者：
Nakase H.
中科院分区：
文献类型：
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作者：
Takeshima Y;Yamada S;Motoyama Y;Park YS;Nakase H.
中枢神经系统生殖细胞瘤常向脑室和蛛网膜下腔扩散。我们报告一位十六岁的男孩，以单纯性生殖细胞瘤表现，表现为食欲不振及头痛十天。放射线检查发现一个大的肿块病变在后颅窝和一个小的肿块病变的松果体小叶增厚的小脑幕和镰。患者通过开放手术部分切除了幕下肿瘤。术中发现硬膜和小脑上肿块病变延伸到蛛网膜下腔。术后给予异环磷酰胺、依托泊苷和顺铂三个化疗疗程。随后给予颅脊髓照射。结论中枢神经系统生殖细胞瘤细胞与脑膜成分的相容性可能与它们与脑脊液或脑室系统的相容性相似。如果在手术干预或其他事件中肿瘤有可能扩展到硬膜下腔，则应考虑诊断后照射范围以覆盖更大范围。
PurposeCentral nervous system germinomas often extend or disseminate into the ventricular and subarachnoid space. We present a case of primary central nervous system germinoma consisting mainly of meningeal dissemination, which is extremely unusual.Case reportA 16-year-old boy presented with pure germinoma, manifesting as anorexia and headache for 10 days. Radiological examinations revealed a large mass lesion in the posterior fossa and a small mass lesion on the pineal lobule with thickening of the tentorium cerebelli and falx. The patient underwent partial removal of the infratentorial tumor via open surgery. Intraoperative findings indicated extension of the dural and supracerebellar mass lesions into the epiarachnoid space. Three chemotherapy courses comprising ifosfamide, etoposide, and cisplatin were administered after the surgery. Craniospinal irradiation was administered subsequently. The adjuvant therapy had a complete response.ConclusionCentral nervous system germinoma cells may have similar compatibility to meningeal components as they do to cerebrospinal fluid or the ventricular system. If there is a possibility of the tumor extending into the subdural space during surgical intervention or other events, a range of postdiagnostic irradiation should be considered to cover a wider range.