Dual Occurrence of Pineal Germinoma and Testicular Seminoma

Abstract

A 16-year-old male presented with obstructive hydrocephalus secondary to pineal germinoma. There have been many reported cases of abdominal metastasis of pineal germinoma after ventriculoperitoneal shunting. Endoscopic ventriculostomy was preferred in our case, thus avoiding iatrogenic peritoneal seeding, but spinal metastasis was unavoidable. Metastatic infiltration of the ventricular system and spinal meninges is the commonest mode of spread. Later, the patient underwent orchidectomy for an asymptomatic left testicular seminoma. He responded to chemotherapy, and had a complete recurrence-free remission for more than 10 years. As far as we know there are only a handful of reported cases of dual occurrence of two primary germ cell tumors (GCT), i.e. gonadal seminoma and pineal germinoma with spinal seeding. We also addressed the controversial subject of radiation versus chemotherapy in the management of patients with pineal germinomas. A review of the relevant literature and recommendations for future treatment of similar cases are discussed.

Is It Destiny or Just Migration Pathway Theory?

“…Interestingly, in our father-son case, we report familial GCT that belongs the same histopathologic subtype. Although Ho and Deruytter [1] advocate that GCT of multifocal origin are a result of migration pathway theory, in our opinion the hereditary component (destiny) could be determinative in addition to the migration pathway theory.…”

“…We read with great interest the article by Ho and Deruytter [1] , in which they report a case of simultaneously occurring pineal germinoma and testicular seminoma. During staging investigations of this 16-year-old patient with pineal germinoma, a second primary testicular tumor was found.…”

“…During staging investigations of this 16-year-old patient with pineal germinoma, a second primary testicular tumor was found. The authors commented that the tumors had multifocal origins on the pathway of germ cell migration because the testicular region is an unusual location of metastasis or seeding [1] . The increased incidence of multifocal tumors in childhood hereditary cancers is a well-described phenomenon [2] .…”

Metachronous Mediastinal Seminoma Occurring After Intracranial Germinoma in an Adolescent

“…[7][8][9][10][11][12] Our assertion that the mediastinal lesion in this case represented metachronous disease is based on the evidence demonstrating that the pineal gland and mediastium are common sites of extragonadal GCTs. These 2 locations are related by virtue of the fact that they are both located along the path of aberrant migration of primordial germ cells during early embryonic development.…”

Germinoma pineal como causa de panhipopituitarismo: reporte de un caso

“…Avondet et al 7 reportan el caso de un paciente masculino de 20 años de edad con un germinoma pineal, que se presentó con diplopía y cefalea persistente y progresiva de un mes de duración. Ho et al 8 describen el caso de un paciente masculino de 16 años de edad con hidrocefalia obstructiva secundaria a un germinoma pineal.…”