Department of Pathology, University of Oklahoma Health Sciences Center
A 5 year-old boy with headache, vomiting, ataxia and a pineal mass.
Clinical information:
The patient was a 5 year-old Vietnamese boy who presented with the chief complaints of headaches, vomiting, and ataxia. CT scan revealed a pineal tumor with small calcifications and hydrocephalus (Panel 1). On MRI, the mass is a well demarcated midline mass involving the pineal area. There is also heterogeneous enhancement and cystic component (Panel 2 and 3).
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Laboratory studies reveal elevated alpha-fetoprotein in both the cerebral spinal fluid (CSF). A clinical diagnosis of primary germ cell tumor was made. The CSF cytology was negative for neoplastic cells. A ventriculoperitoneal shunt was placed to relieve the hydrocephalus and chemotherapy was started. The size of the tumor increased after the chemotherapy and the alpha-fetoprotein level in serum remained elevated. Surgery was performed and yielded multiple fragments of tan, soft tissue, 5.0 x 2.0 x 1.0 cm in aggregate, for examination. On gross examination, neither calcified tissue nor hair were found. The followings are representative histologic images of the excised tumor.
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Cases of the Month Coordinator: KarMing-Fung@ouhsc.edu