De Los Reyes E V A, Rivera D I, Santos H M, Carlos R M
University of the East Ramon Magsaysay Memorial Medical Center, Department of Pathology & Pathology Laboratory, Philippines.
Malays J Pathol. 2018 Aug;40(2):175-183.
Intracranial teratomas account for 0.5% of all intracranial tumours and 2-4% of intracranial tumours in children. However, in terms of tumours of the pineal area, the exact incidence is not ascertained. Although, it is noted that 50-60% of central nervous system (CNS) germ cell tumours are found in the pineal gland. The degree of difficulty in the sampling of lesions in the pineal gland during biopsy emphasizes the importance of correlating the imaging studies, histopathologic findings, and serum and cerebrospinal fluid (CSF) tumour markers.
This case report is that of a 9-year-old male who presented with frontal headache of eight days, with associated photophobia, nausea and vomiting, and diplopia. Biopsy with intraoperative navigation was done and the specimen was referred for histopathologic evaluation. The biopsy showed findings consistent with a mature teratoma with no histologic findings of an immature component or secondary somatic malignancy. Comparison of the pre-operative and post-operative multiaxial cranial CT scan showed findings that was consistent with a residual lesion. This was correlated with the pre-operative serum tumour markers which showed alpha-fetoprotein of 22.5 ng/mL and beta-HCG of 1.0 mIU/mL(IU/L), and the post-operative tumour markers of the cerebrospinal fluid that showed alpha-fetoprotein of 3.28 ng/mL and beta-HCG of 18.9 mIU/mL (IU/L).
A review of the literature and comparison with current case in relation to the histopathologic, serum and CSF findings, and imaging studies was done to better understand the mechanism of this lesion.
颅内畸胎瘤占所有颅内肿瘤的0.5%，占儿童颅内肿瘤的2 - 4%。然而，就松果体区肿瘤而言，确切发病率尚未确定。尽管如此，据指出，50 - 60%的中枢神经系统（CNS）生殖细胞肿瘤发生在松果体。活检时松果体区病变采样的难度强调了将影像学研究、组织病理学发现以及血清和脑脊液（CSF）肿瘤标志物相互关联的重要性。
本病例报告的是一名9岁男性，出现了8天的额部头痛，伴有畏光、恶心、呕吐和复视。进行了术中导航活检，并将标本送去做组织病理学评估。活检显示结果与成熟畸胎瘤一致，没有未成熟成分或继发性体细胞恶性肿瘤的组织学表现。术前和术后多轴头颅CT扫描结果对比显示与残留病变相符。这与术前血清肿瘤标志物相关，术前血清甲胎蛋白为22.5 ng/mL，β - HCG为1.0 mIU/mL（IU/L），术后脑脊液肿瘤标志物显示甲胎蛋白为3.28 ng/mL，β - HCG为18.9 mIU/mL（IU/L）。
回顾文献并将其与当前病例在组织病理学、血清和脑脊液检查结果以及影像学研究方面进行比较，以更好地理解该病变的机制。
