Tsugu Hitoshi, Oshiro Shinya, Ueno Yushi, Abe Hiroshi, Komatsu Fuminari, Sakamoto Seisaburo, Matsumoto Shinji, Nabeshima Kazuki, Fukushima Takeo, Inoue Tooru
Department of Neurosurgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan.
Neurol Med Chir (Tokyo). 2009 Nov;49(11):528-31. doi: 10.2176/nmc.49.528.
A 13-year-old girl presented with an exceedingly rare case of primary yolk sac tumor located within the lateral ventricle, manifesting as headache, nausea, and diplopia. Magnetic resonance imaging revealed a 4-cm-diameter solid enhanced mass within the left inferior horn of the lateral ventricle. The tumor was removed subtotally via left middle temporal corticotomy. The histological and immunohistochemical diagnosis was pure yolk sac tumor. The serum alpha-fetoprotein (AFP) level was elevated at 1957.2 ng/ml and the serum beta-human chorionic gonadotropin level was 4 mIU/ml after surgery. The patient underwent radiotherapy (whole brain, 30 Gy; tumor bed, 21 Gy; whole spinal axis, 30 Gy) and chemotherapy (ifosfamide, cisplatin, etoposide). After three treatment cycles, the serum AFP level had decreased to 4.5 ng/ml. However, the tumor recurred with cerebrospinal fluid dissemination after nine cycles of chemotherapy. She died 18 months after surgery. The possibility of germ cell tumor should be considered in pediatric patients with brain tumors occurring outside the pineal or suprasellar region.
一名13岁女孩患有极为罕见的原发性卵黄囊瘤，位于侧脑室内，表现为头痛、恶心和复视。磁共振成像显示侧脑室左下角有一个直径4厘米的实性强化肿块。通过左颞中皮质切开术对肿瘤进行了次全切除。组织学和免疫组化诊断为纯卵黄囊瘤。术后血清甲胎蛋白（AFP）水平升高至1957.2纳克/毫升，血清β-人绒毛膜促性腺激素水平为4毫国际单位/毫升。患者接受了放疗（全脑30 Gy；瘤床21 Gy；全脊髓轴30 Gy）和化疗（异环磷酰胺、顺铂、依托泊苷）。三个治疗周期后，血清AFP水平降至4.5纳克/毫升。然而，化疗九个周期后肿瘤复发并伴有脑脊液播散。她在手术后18个月死亡。对于松果体或鞍上区域以外发生脑肿瘤的儿科患者，应考虑生殖细胞肿瘤的可能性。
