Occult extracranial malignancy after complete remission of pineal mixed germ cell tumors: a rare case report and literature review
Abstract Background Extracranial metastasis can occur in intracranial germ cell tumors (GCTs), but it is very rare. Recurrence or metastasis of non-germinomatous germ cell tumors (NGGCTs) is often accompanied by elevated tumor markers. Occult extracranial metastases or recurrences with negative ma...
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| Format: | Article |
| Language: | English |
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BMC
2023-09-01
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| Series: | BMC Pediatrics |
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| Online Access: | https://doi.org/10.1186/s12887-023-04213-9 |
| _version_ | 1797556376718802944 |
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| author | Jun Liu Luxiong Fang Songtao Qi Ye Song Lei Han |
| author_facet | Jun Liu Luxiong Fang Songtao Qi Ye Song Lei Han |
| author_sort | Jun Liu |
| collection | DOAJ |
| description | Abstract Background Extracranial metastasis can occur in intracranial germ cell tumors (GCTs), but it is very rare. Recurrence or metastasis of non-germinomatous germ cell tumors (NGGCTs) is often accompanied by elevated tumor markers. Occult extracranial metastases or recurrences with negative markers are often difficult to detect in time, resulting in a very poor prognosis. Case presentation A 12-year-old boy was admitted to our institution with dizziness, headache, vomiting, and sleepiness. Magnetic resonance imaging (MRI) showed a pineal mass, accompanied by a significant increase in serum alpha-fetoprotein (AFP). The patient subsequently underwent total removal of the tumor. Pathology revealed that the tumor was a mixed GCT, consisting of mature teratoma, germinoma, and yolk sac tumor. Intracranial GCT achieved complete remission after intensive adjuvant chemotherapy and radiotherapy. Regular follow-up MRI revealed no recurrence of the intracranial tumor and continued monitoring of tumor markers revealed no abnormalities. Eight months later, the patient was readmitted due to progressive abdominal pain. Imaging and physical examination revealed abdominal occupation and lymphatic mass in the neck. He received salvage chemotherapy, anti-PD-1 immunotherapy, and palliative chemotherapy, but still developed multiple organ dysfunction syndromes (MODS) due to tumor progression and eventually died after one month. Conclusions This profound case suggests that intracranial NGGCTs may develop occult extracranial malignancy, which can be very severe at the time of clinical symptoms and has an extremely poor prognosis. Therefore, in addition to tumor marker monitoring, regular follow-up with extracranial imaging may be warranted to detect extracranial tumors as early as possible, although perhaps not as frequently as with neuroimaging. |
| first_indexed | 2024-03-10T17:01:59Z |
| format | Article |
| id | doaj.art-87b34a8a859c493cb6855377380d8cef |
| institution | Directory Open Access Journal |
| issn | 1471-2431 |
| language | English |
| last_indexed | 2024-03-10T17:01:59Z |
| publishDate | 2023-09-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Pediatrics |
| spelling | doaj.art-87b34a8a859c493cb6855377380d8cef2023-11-20T10:57:04ZengBMCBMC Pediatrics1471-24312023-09-012311610.1186/s12887-023-04213-9Occult extracranial malignancy after complete remission of pineal mixed germ cell tumors: a rare case report and literature reviewJun Liu0Luxiong Fang1Songtao Qi2Ye Song3Lei Han4Department of Neurosurgery, Ganzhou People’s HospitalDepartment of Neurosurgery, Institute of Brain Disease, Nanfang Hospital of Southern Medical UniversityDepartment of Neurosurgery, Institute of Brain Disease, Nanfang Hospital of Southern Medical UniversityDepartment of Neurosurgery, Ganzhou People’s HospitalDepartment of Neurosurgery, Institute of Brain Disease, Nanfang Hospital of Southern Medical UniversityAbstract Background Extracranial metastasis can occur in intracranial germ cell tumors (GCTs), but it is very rare. Recurrence or metastasis of non-germinomatous germ cell tumors (NGGCTs) is often accompanied by elevated tumor markers. Occult extracranial metastases or recurrences with negative markers are often difficult to detect in time, resulting in a very poor prognosis. Case presentation A 12-year-old boy was admitted to our institution with dizziness, headache, vomiting, and sleepiness. Magnetic resonance imaging (MRI) showed a pineal mass, accompanied by a significant increase in serum alpha-fetoprotein (AFP). The patient subsequently underwent total removal of the tumor. Pathology revealed that the tumor was a mixed GCT, consisting of mature teratoma, germinoma, and yolk sac tumor. Intracranial GCT achieved complete remission after intensive adjuvant chemotherapy and radiotherapy. Regular follow-up MRI revealed no recurrence of the intracranial tumor and continued monitoring of tumor markers revealed no abnormalities. Eight months later, the patient was readmitted due to progressive abdominal pain. Imaging and physical examination revealed abdominal occupation and lymphatic mass in the neck. He received salvage chemotherapy, anti-PD-1 immunotherapy, and palliative chemotherapy, but still developed multiple organ dysfunction syndromes (MODS) due to tumor progression and eventually died after one month. Conclusions This profound case suggests that intracranial NGGCTs may develop occult extracranial malignancy, which can be very severe at the time of clinical symptoms and has an extremely poor prognosis. Therefore, in addition to tumor marker monitoring, regular follow-up with extracranial imaging may be warranted to detect extracranial tumors as early as possible, although perhaps not as frequently as with neuroimaging.https://doi.org/10.1186/s12887-023-04213-9Intracranial germ cell tumorExtracranial malignancyOccult tumorTumor markersOutcomesCase report |
| spellingShingle | Jun Liu Luxiong Fang Songtao Qi Ye Song Lei Han Occult extracranial malignancy after complete remission of pineal mixed germ cell tumors: a rare case report and literature review BMC Pediatrics Intracranial germ cell tumor Extracranial malignancy Occult tumor Tumor markers Outcomes Case report |
| title | Occult extracranial malignancy after complete remission of pineal mixed germ cell tumors: a rare case report and literature review |
| title_full | Occult extracranial malignancy after complete remission of pineal mixed germ cell tumors: a rare case report and literature review |
| title_fullStr | Occult extracranial malignancy after complete remission of pineal mixed germ cell tumors: a rare case report and literature review |
| title_full_unstemmed | Occult extracranial malignancy after complete remission of pineal mixed germ cell tumors: a rare case report and literature review |
| title_short | Occult extracranial malignancy after complete remission of pineal mixed germ cell tumors: a rare case report and literature review |
| title_sort | occult extracranial malignancy after complete remission of pineal mixed germ cell tumors a rare case report and literature review |
| topic | Intracranial germ cell tumor Extracranial malignancy Occult tumor Tumor markers Outcomes Case report |
| url | https://doi.org/10.1186/s12887-023-04213-9 |
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