Mixed germ cell tumors with abundant sarcomatous component in the temporal lobe after radiochemotherapy of neurohypophyseal germinoma: a case report

Abstract

We report a case of intracranial germ cell tumor that showed pathological changes from neurohypophyseal germinoma to mixed germ cell tumors consisting exclusively of undifferentiated sarcomatous component after radiochemotherapy. Three surgical specimens and autopsied brain from the patient were histologically examined. An initial specimen from the neurohypophyseal tumor was diagnosed as germinoma with a two-cell pattern. Five years later, after repeated radiochemotherapy, the second specimen resected from the right temporal lobe showed mixed germ cell tumors consisting of the three components of germinoma, choriocarcinoma, and immature teratoma. Six months later after intensive radiotherapy, the right temporal tumor recurred and was surgically removed. The histological diagnosis was mixed germ cell tumors with abundant immature teratoma component. The patient died of uncontrollable tumor growth with repeated intratumoral hemorrhages. The autopsied brain showed sarcoma with angionecrosis. This pathological alteration indicated an increase in the sarcomatous component after undergoing various treatments. We discuss the histological changes of intracranial germ cell tumor modified by treatment.

Germinoma with malignant transformation to nongerminomatous germ cell tumor

“…On resection, histological examination revealed an immature teratoma. Kamitani et al 9 described a second case in which a sellar/suprasellar germinoma with syncytiotrophoblastic giant cells (on presentation, secreting low levels of b-HCG) recurred 3 years after platinum and etoposide chemotherapy and whole-brain irradiation with local boost. This recurrence was found in the right temporal lobe, with malignant transformation to a mixed germ cell tumor.…”

A rapidly expanding immature teratoma originating from a neurohypophyseal germinoma

“…The high occurrence of mixed GCTs may support the existence of such cells. There are several literature reports of conversion of a germinoma into other GCT [5,6]. In those reports, however, chemoradiation therapy was given to the first tumour, and the possibility of recurrence from a preexisting malignant component, which survived the therapy, could not be ruled out.…”