A primary third ventricle mixed germ cell tumor with leptomeningeal dissemination of immature teratoma component

  • Mustafa Kemal Demir
  • Ozlem Yapıcıer
  • Omer Faruk Karakaya
  • Başak Mert
  • Askın Seker
Case Report


A 17-year-old male patient presented to the clinic with a headache, nausea, and vomiting. Magnetic resonance imaging demonstrated a fat-containing and -enhancing heterogeneous tumor in the third ventricle, and fat droplets within the ventricles and the subarachnoid space. Obstructive hydrocephalus was also present. Emergency subtotal removal of the mass was performed via interhemispheric transcallosal approach. The histopathological diagnosis was a mixed germ cell tumor that was composed of embryonal carcinoma, yolk-sac tumor, germinoma, and immature teratoma containing a large amount of mature elements. The patient was referred for postoperative chemoradiotherapy. A mixed germ cell tumor is a rare type of nongerminomatous germ cell tumor that is made up of at least two different types of germ cell tumors. These may include germinoma, choriocarcinoma, embryonal carcinoma, yolk sac tumor, mature teratoma, immature teratoma, or teratoma with malignant degeneration. As far as we know, this is the first reported case of a primary third ventricle mixed germ cell tumor with leptomeningeal dissemination of the immature teratoma component that contains grossly visible mature elements at admission.


Mixed germ cell tumors Third ventricle Mature teratoma Leptomeningeal dissemination Magnetic resonance imaging 


Compliance with ethical standards

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.


  1. 1.
    DM LHC (1992) Primary intracranial germ cell tumor. Pathologic study of 51 patients. Cancer 70:1577–1584CrossRefGoogle Scholar
  2. 2.
    Packer RJ, Cohen BH, Cooney K (2000) Intracranial germ cell tumors. Oncologist 5:312–320Google Scholar
  3. 3.
    Yoneoka Y, Yoshimura J, Sano M, Okada M, Kakita A, Fujii Y (2018) Third ventricle germ cell tumor originating from the infundibulum with rapidly expansive enlargement. Pediatr Neurosurg 53:49–54. CrossRefGoogle Scholar
  4. 4.
    Kishore M, Monappa V, Rao L, Kudva R (2014) Mixed malignant germ cell tumour of third ventricle with hydrocephalus: a rare case with recurrence. J Clin Diagn Res 8(11):FD03–FD05. Google Scholar
  5. 5.
    Iwasaki I, Horie H, Yu TJ, Ariga N, Ohwada T, Oka Y, Asanuma K (1985) Intracranial embryonal carcinoma mixed with endodermal sinus tumor and teratomatous elements in the anterior third ventricle--case report. Neurol Med Chir (Tokyo) 25:554–558CrossRefGoogle Scholar
  6. 6.
    Yang KH, Jin SD, Lee EJ, Lee KY, Gang SJ, Kim BK, Kim SM (1988) Mixed germ cell tumor in third ventricle: a report of case. Korean J Pathol 22:118–122Google Scholar
  7. 7.
    Haas-Kogan DA, Missett BT, Wara WM, Donaldson SS, Lambor KR, Prados MD, Fisher PG et al (2003) Radiation therapy for intracranial germ cell tumors. Int J Radiat Oncol Biol Phys 56:511–518CrossRefGoogle Scholar
  8. 8.
    Sano K, Matsutani M, Seto T (1989) So-called intracranial germ cell tumours: personal experiences and a theory of their pathogenesis. Neurol Res 11:118–126CrossRefGoogle Scholar
  9. 9.
    Louis DN, Perry A, Reifenberger G, von Deimling A, Figarella-Branger D, Cavenee WK, Ohgaki H, Wiestler OD, Kleihues P, Ellison DW (2016) The 2016 World Health Organization classification of tumors of the central nervous system: a summary. Acta Neuropathol 131:803–820. CrossRefGoogle Scholar
  10. 10.
    Kyritsis AP (2010) Management of primary intracranial germ cell tumors. J Neuro-Oncol 96:143–149CrossRefGoogle Scholar
  11. 11.
    Lieuw KH, Haas-Kogan D, Ablin A (2004) Intracranial germ cell tumors. In: Gupta N, Banerjee A, Haas-Kogan D (eds) Pediatric CNS tumors. Springer-Verlag, New York, pp 107–121CrossRefGoogle Scholar
  12. 12.
    Jennings MT, Gelman R, Hochberg F (1985) Intracranial germ-cell tumors: natural history and pathogenesis. J Neurosurg 63:155–167CrossRefGoogle Scholar
  13. 13.
    Suh DY, Mapstone T (2001) Pediatric supratentorial intraventricular tumors. Neurosurg Focus 10(6):E4CrossRefGoogle Scholar
  14. 14.
    Ahmed SI, Javed G, Laghari AA, Bareeqa SB, Aziz K, Khan M, Samar SS, Humera RA, Khan AR, Farooqui MO, Shahbaz A (2018) Third ventricular tumors: a comprehensive literature review. Cureus 10(10):e3417. Google Scholar
  15. 15.
    Abdelmuhdi AS, Almazam AE, Dissi NA, Albastaki UM, Pierre-Jerome C (2017) Intracranial teratoma: imaging, intraoperative, and pathologic features: AIRP best cases in radiologic-pathologic correlation. Radiographics 37:1506–1511. CrossRefGoogle Scholar
  16. 16.
    Allen JC (1991) Controversies in the management of intracranial germ-cell tumors. Neurol Clin 9:441–452CrossRefGoogle Scholar
  17. 17.
    Demir MK, Yapıcıer O, Onat E, Toktaş ZO, Akakın A, Urgun K, Kılıç T (2014) Rare and challenging extra-axial brain lesions: CT and MRI findings with clinico-radiological differential diagnosis and pathological correlation. Diagn Interv Radiol 20:448–452. CrossRefGoogle Scholar
  18. 18.
    Karabulut N, Oguzkurt L (2000) Tetraventricular hydrocephalus due to ruptured intracranial dermoid cyst. Eur Radiol 10:1810–1811CrossRefGoogle Scholar
  19. 19.
    Matsutani M (2001) Combined chemotherapy and radiation therapy for CNS germ cell tumors--the Japanese experience. J Neuro-Oncol 54:311–316CrossRefGoogle Scholar
  20. 20.
    Huang X, Zhang R, Mao Y, Zhou LF, Zhang (2016) Recent advances in molecular biology and treatment strategies for intracranial germ cell tumors. World J Pediatr 12(3):275–282CrossRefGoogle Scholar
  21. 21.
    Fetcko K, Dey M (2018) Primary central nervous system germ cell tumors: a review and update. Med Res Arch 6(3).
  22. 22.
    Calaminus G, Frappaz D, Kortmann RD, Krefeld B, Saran F, Pietsch T et al (2017) Outcome of patients with intracranial non-germinomatous germ cell tumors-lessons from the SIOP-CNS-GCT-96 trial. Neuro Oncol 19(12):1661–1672. CrossRefGoogle Scholar
  23. 23.
    Murray MJ, Bartels U, Nishikawa R, Fangusaro J, Matsutani M, Nicholson JC (2015) Consensus on the management of intracranial germ-cell tumours. Lancet Oncol 16(9):e470–e477CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Radiology, Bahçeşehir University School of MedicineGöztepe Medical Park Training and Education HospitalIstanbulTurkey
  2. 2.Department of Pathology, Bahçeşehir University School of MedicineGöztepe Medical Park Training and Education HospitalIstanbulTurkey
  3. 3.Bahçeşehir University School of MedicineIstanbulTurkey
  4. 4.Department of Neurosurgery, Altınbas University Faculty of MedicineBahçelievler Medical Park HospitalIstanbulTurkey

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