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.

Keywords:
Pineal germinoma, Endoscopic ventriculostomy, Testicular seminoma, Radiotherapy, Chemotherapy
1.
Peat DS, Trowell JE: Testicular seminoma in a patient with pineal germinoma. J Clin Pathol 1994;47:771–772.
2.
Chao CKS, Lee ST, Lin FJ, Tang SG, Leung WM: A multivariate analysis of prognostic factors in management of pineal tumours. Int J Radiat Oncol Biol Phys 1993;27:1185–1191.
3.
Howman GR, Besser M, Johnston IH, Da Silva M: Disseminated hematogenous metastases from a pineal germinoma in an infant. J Neurosurg 1984;60:835–837.
4.
Devkota J, Brooks BS, El Gammal T: Ventriculoperitoneal shunt metastasis of a pineal germinoma. Comput Radiol 1984;8:141–145.
5.
Ung AO, Triscott JA, Leditschke JF, Smith JA: Metastasis of pineal germinoma via ventriculoperitoneal shunt. Aust NZ J Surg 1993;63:409–412.
6.
Levin CV, Rutherfoord GS: Metastasizing pineal germinoma. A case report and review. S Afr Med J 1985;68:36–39.
7.
Wara WM, Jenkin RD, Evans A, Ertel I, Hittle R, Ortega J, Wilson CB, Hammond D: Tumors of the pineal and suprasellar region: Children’s Cancer Study Group treatment results 1960–1975: a report from Children’s Cancer Study Group. Cancer 1979 43:698–701.
8.
Tsunoda S, Sasaoka Y, Sasaki T, Morimoto T, Ken-ichiro Hiramatsu, Shoichiro Kawaguchi, Ishida Y, Goda K: Suprasellar embryonal carcinoma which developed ten years after local radiation therapy for pineal germinoma. Surg Neurol 1993;40:146–150.
9.
Tretini GP, Maiorana A, De Beneditis A: Metachronous seminoma of the pineal region and the right testis. Appl Pathol 1985;3:129–133.
10.
Tokoro K, Chiba Y, Murase S, Yagishita S, Kyuma Y: Subarachnoid dissemination of pineal germinoma 9 years after radiation therapy without local relapse. Neurol Med Chir (Tokyo) 1991;31:725–728.
11.
Maity A, Shu HK, Janss A, Belasco JB, Rorke L, Philips PC, Sutton LN, Goldwein JW: Craniospinal radiation in the treatment of biopsy-proven intracranial germinomas: twenty-five years’ experience in a single center. Int J Radiat Oncol Biol Phys 2004;58:1165–1170.
12.
Matsutani M, Sano K, Takakura K, Fujimaki T, Nakamura O, Funata N, Seto T: Primary intracranial germ cell tumours: a clinical analysis of 153 histologically verified cases. J Neurosurg 1997;86:446–455.
13.
Ogawa K, Shikama N, Toita T, Nakamura K, Uno T, Onishi H, Itami J, Kakinohana Y, Kinjo T, Yoshii Y, Ito H, Murayama S: Long-term results of radiotherapy for intracranial germinoma: a multi-institutional review of 126 patients. Int J Radiat Oncol Biol Phys 2004;58:705–713.
14.
Packer RJ, Cohen BH, Coney K: Intracranial germ cell tumors. Oncologist 2000;5:312–320.
15.
Hardenberg PH, Golden J, Billet A, et al: Intracranial germinomas: the case for lower dose radiation therapy. Int J Radiat Oncol Biol Phys 1997;39:419–426.
16.
Haddock MG, Schild SE, Scheithauer BW, et al: Radiation therapy for histologically confirmed primary central nervous system germinoma. Int J Radiat Oncol Biol Phys 1997;38:915–923.
17.
Dearnaley DP, Whittaker S, Bloom HJG: Pineal and germ cell tumours: Royal Marsden Hospital experience 1962–1987. Int J Radiation Oncol Biol Phys 1990;18:773–781.
18.
Salazar OM, Castro-Vita H, Bakos RS, Feldstein ML, Keller B, Rubin P: Radiation therapy for tumors of the pineal region. Int J Radiat Oncol Biol Phys 1979;5:491–499.
19.
Baranzelli MG, Patte C, Bouffet E, et al: Nonmetastatic intracranial germinoma: the experience of the french society of pediatric oncology. Cancer 1997;80:1792–1797.
20.
Farng KT, Chang KP, Wong TT, Guo WY, Ho DM, Hu WL: Pediatric intracranial germinoma treated with chemotherapy alone. Zhonghua Yi Xue Za Zhi (Taipei) 1999;62:859–866.
21.
Allen JC, Kim JH, Packer RJ: Neoadjuvant chemotherapy for newly-diagnosed germ-cell tumours of the CNS. J Neurosurg 1987;67:65–70.
22.
Balmaceda C, Heller G, Rosenblum M, et al: Chemotherapy without irradiation: a novel approach for newly-diagnosed central nervous system (CNS) germ-cell tumours (GCT): results of an international cooperative trial. J Clin Oncol 1994;14:2908–2915.
23.
Pallini R, Bozzini V, Scerrati M, Zuppi C, Zappacosta B, Rossi GF: Bone metastasis associated with shunt-related peritoneal deposits from a pineal germinoma. Acta Neurochir (Wien) 1991;109:78–83.
24.
Pinkerton CR, Broadbent V, Horwich A, Levitt J, McElwain TJ, Meller ST: ‘JEB’ – a carboplatin-based regimen for malignant germ cell tumors in children. Br J Cancer 1990;62:257–262.
25.
Borden S 4th, Weber AL, Toch R, Wang CC: Pineal germinoma. Long-term survival despite hematogenous metastases. Am J Dis Child 1973;126:214–216.
26.
Wood BP, Haller JO, Berdow WE, Lin SR: Shunt metastases of pineal tumors presenting as pelvic mass. Paediatr Radiol 1979;8:108–109.
27.
Manor R, Bar Ziv J, Tadmor R, Eisbruch A, Rechavi G: Pineal germinoma with unilateral blindness. J Clin Neuroopthalmol 1990;10:239–243.
28.
Kun LE, Tang TT, Sty JR, Camitta BM: Primary cerebral germinoma and ventriculoperitoneal shunt metastases. Cancer 1981;48:213–216.
29.
Triolo PJ, Schulz EE: Metastatic germinoma (pinealoma) via a ventriculoperitoneal shunt. Am J Roentgenol 1980;135:854–855.
30.
Neuwelt EA, Glasberg M, Frenkel E, Clark K: Malignant pineal region tumors. A clinico-pathological study. J Neurosurg 1979;51:597–607.
31.
Pelissou I, Ravon R, Moreau JJ, Mokhtari F, Vire O: Métastases multiples au cours de l’évolution d’un germinome pineal. Neurochirurgie 1985;31:537–540.
32.
Itoyama Y, Masato K, Yamashiro S, Yoshizato K, Kuratsu JI, Ushio Y: Combination chemotherapy with cisplatin and ethoposide for hematogenous spinal metastasis of intracranial germinoma. Neurol Med Chir (Tokyo) 1993;33:28–31.
33.
Talamo TS, Mendelow H: Primary intracranial germinoma with massive ventriculoperitoneal shunt metastases. J Surg Oncol 1985;28:39–41.
34.
Haimovic IC, Sharer L, Hyman RA, Bereford HR: Metastasis of intracranial germinoma through a ventriculoperitoneal shunt. Cancer 1981;48:1033–1036.
35.
Ferraresi S, Cassinari V, Bani G, Biroli F, Carminati P: Extranervous localization of a presumed suprasellar and pineal germinoma. Eur Neurol 1989;29:171–173.
36.
Sano K, Matsutani M: Pinealoma (germinoma) treated by direct surgery and post-operative irradiation. Childs Brain 1981;8:81–97.
37.
Jenkin D, Berry M, Chan H: Pineal region germinomas in childhood; treatment considerations. Int J Radiat Oncol Biol Phys 1989;18:541–545.
38.
Sutton LN, Radcliffe J, Goldwein JW, et al: Quality of life of adult survivors of germinoma treated with craniospinal irradiation. Neurosurgery 1999;45:1291–1298.
© 2006 S. Karger AG, Basel
2005
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.