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Case Reports in Medicine
Volume 2018, Article ID 5106701, 7 pages
https://doi.org/10.1155/2018/5106701
Case Report

A Case of Nongerminomatous Germ Cell Tumor of the Pineal Region: Risks and Advantages of Biopsy by Endoscopic Approach

Department of Neurosurgery, Umberto I General Hospital, Università Politecnica delle Marche, Ancona, Italy

Correspondence should be addressed to Mauro Dobran; ti.orebil@narbod

Received 27 November 2017; Revised 30 January 2018; Accepted 15 February 2018; Published 11 March 2018

Academic Editor: Ting Fan Leung

Copyright © 2018 Mauro Dobran et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

A 21-year-old male was admitted to our department with headache and drowsiness. CT scan and MRI revealed acute obstructive hydrocephalus caused by a pineal region mass. The serum and CSF levels of beta-human chorionic gonadotropin (beta-hCG) were 215 IU/L and 447 IU/L, respectively, while levels of alpha-fetoprotein (AFP) were normal. A germ cell tumor (GCT) was suspected, and the patient underwent endoscopic third ventriculostomy (ETV) with biopsy. After four days from surgery, the tumor bled with mass expansion and ETV stoma occlusion; thus, a ventriculoperitoneal shunt was positioned. After ten months, the tumor metastasized to the thorax and abdomen with progression of intracerebral tumor mass. Despite the aggressive nature of this tumor, ETV remains a valid approach for a pineal region mass, but in case of GCT, the risk of bleeding should be taken into account, during and after the surgical procedure.