MUDr, PhD. Vera Miskovska, MUDr., PhD. Vanda Usakova, MUDr., PhD. Bibiana Vertakova-Krakovska, MUDr., PhD. Bela Mrinakova, MUDr., PhD. Viera Lehotska, MUDr. Martin Chorvath, MUDr., PhD. Boris Rychly, Prof. MUDr. PhD. Juraj Steno, Prof. MUDr. DrSc. Dalibor Ondrus


Background: Primary intracranial germ cell tumours represent a rare category of neoplasms, which occur in childhood and in young adults. The WHO classification divides intracranial tumours into germinomas and non- germinomas. The most frequent locality of these tumours is pineal and suprasellar region. Clinical signs and symptoms depend on the tumour’s localization, they most commonly include signs of increased intracranial pressure, Parinaud’s syndrome, bitemporal hemianopsy, signs of endocrine deficiency. Gadolinium enhanced MRI scan of the brain is the imagining examination of choice in the diagnostic strategy of intracranial germ cell tumours. The imagining studies do not provide sufficient information about histological type therefore the biopsy is necessary. The exception represents cases with characteristically increased levels of tumour markers /AFP a β-HCG/ measured in the serum and cerebrospinal fluid.

Case: A pineal germ cell tumor was observed in 26-year old male with presentation of eyesight disorder with focusing difficulty and photophobia, accompanied by intensive fatigue and sleepiness, nausea with occasional vomitus, intermittent headache and Parinaud’s syndrome. MRI examination of the brain showed tumour expansion in the pineal region and in the right part of the mesencephalon. The radical extirpation of the tumour in pineal region was performed. The follow-up MRI scan of the brain revealed a relapse of the disease. Patient underwent craniospinal radiation therapy with subsequent postoperative chemotherapy (scheme cisplatin and etoposide), overall three cycles. Currently the patient is 30 months after accomplishment of oncological treatment in clinical remission of the disease.

Conclusion: The treatment and prognoses of this neoplasm differs between particular categories. Germinomas have better survival rates than non- germinomas. A 5-year survival rate of germinoma’s patients after application of radiotherapy alone was >  90% of cases. The addition of chemotherapy lead to a decrease of the dose and minimalization of the irradiated area, with achievement of less side effects without a decrease of the curability. Non-germinomas are less radiosensitive than germinomas, but after the application of the adjuvant chemotherapy, survival benefit was achieved. However the optimal management of these tumours remains controversial.

Klíčová slova

primary intracranial germ cell tumours, diagnostic, treatment

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