In 1980, a 10-year-old boy was admitted to the authors' hospital with consciousness disturbance and
vomiting. Computerized tomography (CT) scans revealed a pineal mass lesion and
hydrocephalus. The
tumor was totally removed and a ventriculoperitoneal (VP) shunt was inserted. Histological investigation of a surgical specimen revealed that it was a
teratoma. Five years later, the patient was readmitted to the same institution with
polyuria. Magnetic resonance (MR) imaging revealed a mass lesion in the suprasellar region. The patient received systemic
chemotherapy, and the
tumor disappeared; however, 2 years after the
chemotherapy, MR imaging demonstrated a right lateral ventricular mass. The
tumor was totally resected, and histopathological investigation revealed a
teratocarcinoma. Three years after the
chemotherapy, CT scanning revealed suprasellar and right lateral ventricular
tumor recurrences, for which the patient received irradiation and
chemotherapy. The
tumors disappeared and the patient achieved complete remission that lasted longer than 10 years. On January 25, 2000, however, he noticed hip
pain. Lumbar MR imaging demonstrated a spinal
tumor below L-4 and also an abdominal
tumor. The abdominal
tumor was totally removed, and the histological findings identified it as a
germinoma. The patient received systemic
chemotherapy and the
tumor disappeared completely. The authors believe that the suprasellar
tumor was a metachronous
germinoma and that it had metastasized through the intrathecal route and the VP shunt.