GCT-44. A CASE OF INTRACRANIAL GERMINOMA WHICH RECURRED IN THE SPINAL CORD 13 YEARS AFTER THE INITIAL TREATMENT

Abstract BACKGROUND Central nervous system germinoma occurs most often in early teens, accounting for 15% of childhood brain tumors. Here, we report a case of germinoma which recurred in the spinal cord 13 years after complete remission. CASE DESCRIPTION: A 15-year-old boy presented with diabetes insipidus (DI). MRI showed a pineal gland tumor and ventriculomegaly. Biopsy was performed and the histological examinations revealed PLAP and c-kit positive pure germinoma. Ki67 LI was 64.4%. Gamma knife radiosurgery and 3 courses of ICE chemotherapy brought disappearance of the tumor. However, it recurred in lateral ventricles. Forty-Gray whole brain radiation resulted in complete remission of the tumor. For the sake of DI treatment and MRI examinations, he kept periodical visit to our hospital. Thirteen years later, when he was 28y/o, he complained paresthesia in the right upper extremity. MRI demonstrated gadolinium-enhance mass lesion in the cervical spinal cord. Recurrence of the tumor and multiple sclerosis were the principal differential diagnosis. Pulse steroid therapy did not make any change, and radiation therapy to the cervical spinal cord led to tumor disappearance. Nevertheless, the tumor recurred on the dorsal medulla oblongata one and a half years later. Biopsy of the tumor clarified that the tumor was germinoma. ICE chemotherapy which was limited to three courses due to severe bone marrow suppression was carried out. MRI proved no enhanced mass lesion in the central nervous system. DISCUSSION Germinoma may recur even after long period of remission, demonstrating that long-term follow-up is indispensable.