Talamonti Giuseppe, Ligarotti Gianfranco K, Bramerio Manuela, Imbesi Francesca
Department of Neurosurgery, AO Niguarda, Milan, Italy.
BMJ Case Rep. 2013 Aug 2;2013:bcr2013200278. doi: 10.1136/bcr-2013-200278.
A previously healthy man underwent endoscopic biopsy for a suspected pineal germinoma. Histology and immunohistochemistry did not confirm the preoperative diagnosis, and neurosarcoidosis was hypothesised because of the presence of granulomatous reaction. The patient remained in good health for 3 years and was still asymptomatic when a control MRI showed metastasis implantation along the endoscopic route. A redobiopsy provided the diagnosis of germinoma, but was complicated by severe ventricular haemorrhage requiring emergency clot excision. Postoperative clinical conditions were so severe that the treatment of germinoma was postponed. Three months later, repeated MRI showed tumour progression. Chemotherapy promoted good tumour regression so that the treatment was completed by radiation therapy. The tumour completely disappeared on MRI, but the patient remained severely disabled because of the haemorrhage.
一名既往健康的男性因疑似松果体生殖细胞瘤接受了内镜活检。组织学和免疫组化检查未证实术前诊断，由于存在肉芽肿反应，推测为神经结节病。患者健康状况良好达3年，当对照MRI显示沿内镜路径有转移灶植入时仍无症状。再次活检确诊为生殖细胞瘤，但并发严重的脑室出血，需要紧急清除血凝块。术后临床情况极为严重，以至于生殖细胞瘤的治疗被推迟。三个月后，重复MRI显示肿瘤进展。化疗使肿瘤明显消退，因此通过放射治疗完成了治疗。MRI显示肿瘤完全消失，但由于出血，患者仍严重残疾。
