Murai Y, Kobayashi S, Mizunari T, Ohaki Y, Adachi K, Teramoto A
Department of Neurosurgery, Nippon Medical School, Chiba Hokusoh Hospital, Japan.
J Neurosurg. 2000 Nov;93(5):884-6. doi: 10.3171/jns.2000.93.5.0884.
The authors report a case in which a germinoma in the pineal body displayed spontaneous regression after placement of a ventriculoperitoneal (VP) shunt. Spontaneous regression of malignant tumors is extremely rare, occurring in only one of 60,000 to 100,000 patients. Although in rare cases spontaneous regression is known to occur in patients with testicular seminomas, only one case of spontaneous regression of a primary pineal germinoma has so far been reported. In the present case a 17-year-old man presented with headache. A tumor in the pineal body and acute hydrocephalus were revealed by head computerized tomography (CT) and magnetic resonance (MR) imaging, and VP shunt placement was performed. Computerized tomography scanning of the head was performed four times during a 2-week period following the operation, and the patient was temporarily discharged to return to school. At the time of discharge, CT scanning demonstrated no change in the size of the tumor. Two months later, the patient was readmitted to the hospital to undergo surgery. At that time, head MR imaging revealed regression of the tumor. The pathological diagnosis of the lesion was germinoma. The patient underwent three courses of chemotherapy, during which carboplatin and etoposide were administered, in addition to a 24-Gy dose of radiotherapy. No manifestations of nerve impairment were noticed, and the patient was observed on an outpatient basis. The authors think that the factors involved in tumor regression included the effects of the VP shunt, the effects of radiation absorbed during head CT scanning, and the role of the patient's own immune response. However, no conclusion has been reached concerning the actual cause.
作者报告了一例松果体生殖细胞瘤在置入脑室腹腔（VP）分流管后出现自发消退的病例。恶性肿瘤的自发消退极为罕见，仅发生于6万至10万患者中的1例。虽然已知睾丸精原细胞瘤患者在罕见情况下会出现自发消退，但迄今为止仅报道过1例原发性松果体生殖细胞瘤自发消退的病例。在本病例中，一名17岁男性因头痛就诊。头部计算机断层扫描（CT）和磁共振（MR）成像显示松果体区有肿瘤及急性脑积水，遂进行了VP分流管置入术。术后2周内对头部进行了4次CT扫描，患者暂时出院返校。出院时，CT扫描显示肿瘤大小无变化。两个月后，患者再次入院接受手术。此时，头部MR成像显示肿瘤已消退。病变的病理诊断为生殖细胞瘤。患者接受了3个疗程的化疗，期间给予卡铂和依托泊苷，此外还进行了24 Gy的放疗。未发现神经功能损害表现，对患者进行门诊观察。作者认为肿瘤消退的相关因素包括VP分流管的作用、头部CT扫描时吸收的辐射作用以及患者自身免疫反应的作用。然而，关于实际病因尚未得出结论。
