Pineal germinoma in a young adult: A case report
Abstract Background Intracranial germinomas (GN) are rare cancers that primarily affect children, making them rarer still in adults. Standard treatment for this neoplasm includes neoadjuvant chemotherapy (NC) followed by radiotherapy (RT) or RT at a higher dose and larger field. These recommendation...
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| Format: | Article |
| Language: | English |
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Wiley
2022-09-01
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| Series: | Cancer Reports |
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| Online Access: | https://doi.org/10.1002/cnr2.1611 |
| _version_ | 1811210433530429440 |
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| author | Lissett Jeanette Fernández‐Rodríguez Xavier Maldonado‐Pijoan |
| author_facet | Lissett Jeanette Fernández‐Rodríguez Xavier Maldonado‐Pijoan |
| author_sort | Lissett Jeanette Fernández‐Rodríguez |
| collection | DOAJ |
| description | Abstract Background Intracranial germinomas (GN) are rare cancers that primarily affect children, making them rarer still in adults. Standard treatment for this neoplasm includes neoadjuvant chemotherapy (NC) followed by radiotherapy (RT) or RT at a higher dose and larger field. These recommendations are based on studies focused mostly on children; it is currently unclear whether this treatment is applicable to adults. Case We present a case of a 23‐year‐old adult male with no underlying pathologies, drug allergies, or family history of cancer, who presented for medical evaluation with blurred vision, diplopia, forgetfulness, and weight loss starting 3–4 months before the evaluation. Clinical examination indicated Parinaud's Syndrome. Magnetic resonance imaging (MRI) and computed tomography (CT) revealed a pineal tumor with ependymal dissemination in both lateral ventricles, which was causing obstructive hydrocephalus. The patient had surgery consisting of ventriculostomy, Holter shunt insertion, cisternal ventricular intubation, and cisterna magna anastomosis to improve ventricular drainage. Pathology confirmed pineal germinoma. Cerebrospinal fluid cytology and MRI of the axis were negative. Four cycles of NC were given to the patient (carboplatin, etoposide, and ifosfamide), with reduced dosage. Once a partial volumetric response was confirmed, whole‐ventricular radiotherapy (WVR) was initiated with a total tumor bed dose of 45 Gy over 25 sessions in 5 weeks. Optimum clinical results were observed, and no short‐term (<90 day) radiation toxicity was observed. The patient was able to resume his normal activities soon after treatment. Follow‐ups over 2 years post‐surgery indicated continued control of the lesion and absence of symptoms except for mild diplopia. Conclusion Although this is a case report, these data suggest that a reduced NC course and WVR may effectively treat adult GN. This protocol likely decreases the risk of undesirable NC and RT secondary effects, while providing excellent local control; however, using a narrower RT field is not recommended. |
| first_indexed | 2024-04-12T04:55:27Z |
| format | Article |
| id | doaj.art-2b725625a9854370abc20b757775062c |
| institution | Directory Open Access Journal |
| issn | 2573-8348 |
| language | English |
| last_indexed | 2024-04-12T04:55:27Z |
| publishDate | 2022-09-01 |
| publisher | Wiley |
| record_format | Article |
| series | Cancer Reports |
| spelling | doaj.art-2b725625a9854370abc20b757775062c2022-12-22T03:47:08ZengWileyCancer Reports2573-83482022-09-0159n/an/a10.1002/cnr2.1611Pineal germinoma in a young adult: A case reportLissett Jeanette Fernández‐Rodríguez0Xavier Maldonado‐Pijoan1School of Medicine Universidad Privada Antenor Orrego Trujillo La Libertad PeruOncology and Radiotherapy Service Hospital Universitario Vall d'Hebron Barcelona SpainAbstract Background Intracranial germinomas (GN) are rare cancers that primarily affect children, making them rarer still in adults. Standard treatment for this neoplasm includes neoadjuvant chemotherapy (NC) followed by radiotherapy (RT) or RT at a higher dose and larger field. These recommendations are based on studies focused mostly on children; it is currently unclear whether this treatment is applicable to adults. Case We present a case of a 23‐year‐old adult male with no underlying pathologies, drug allergies, or family history of cancer, who presented for medical evaluation with blurred vision, diplopia, forgetfulness, and weight loss starting 3–4 months before the evaluation. Clinical examination indicated Parinaud's Syndrome. Magnetic resonance imaging (MRI) and computed tomography (CT) revealed a pineal tumor with ependymal dissemination in both lateral ventricles, which was causing obstructive hydrocephalus. The patient had surgery consisting of ventriculostomy, Holter shunt insertion, cisternal ventricular intubation, and cisterna magna anastomosis to improve ventricular drainage. Pathology confirmed pineal germinoma. Cerebrospinal fluid cytology and MRI of the axis were negative. Four cycles of NC were given to the patient (carboplatin, etoposide, and ifosfamide), with reduced dosage. Once a partial volumetric response was confirmed, whole‐ventricular radiotherapy (WVR) was initiated with a total tumor bed dose of 45 Gy over 25 sessions in 5 weeks. Optimum clinical results were observed, and no short‐term (<90 day) radiation toxicity was observed. The patient was able to resume his normal activities soon after treatment. Follow‐ups over 2 years post‐surgery indicated continued control of the lesion and absence of symptoms except for mild diplopia. Conclusion Although this is a case report, these data suggest that a reduced NC course and WVR may effectively treat adult GN. This protocol likely decreases the risk of undesirable NC and RT secondary effects, while providing excellent local control; however, using a narrower RT field is not recommended.https://doi.org/10.1002/cnr2.1611case reportgerminomaintensity‐modulated radiotherapyneurosurgerypineal gland |
| spellingShingle | Lissett Jeanette Fernández‐Rodríguez Xavier Maldonado‐Pijoan Pineal germinoma in a young adult: A case report Cancer Reports case report germinoma intensity‐modulated radiotherapy neurosurgery pineal gland |
| title | Pineal germinoma in a young adult: A case report |
| title_full | Pineal germinoma in a young adult: A case report |
| title_fullStr | Pineal germinoma in a young adult: A case report |
| title_full_unstemmed | Pineal germinoma in a young adult: A case report |
| title_short | Pineal germinoma in a young adult: A case report |
| title_sort | pineal germinoma in a young adult a case report |
| topic | case report germinoma intensity‐modulated radiotherapy neurosurgery pineal gland |
| url | https://doi.org/10.1002/cnr2.1611 |
| work_keys_str_mv | AT lissettjeanettefernandezrodriguez pinealgerminomainayoungadultacasereport AT xaviermaldonadopijoan pinealgerminomainayoungadultacasereport |