Mediastinal metastases from a primary immature teratoma of the CNS

Sultan M. Zain, MPH; Kanish Mirchia, MD; Kristyn Galbraith, MD; Michael A. Galgano, MD; Mijung Lee, MD; Timothy E. Richardson, DO, PhD; Kavya Mirchia, MD

Radiology Case Reports (Sep 2022)

Mediastinal metastases from a primary immature teratoma of the CNS

Sultan M. Zain, MPH,
Kanish Mirchia, MD,
Kristyn Galbraith, MD,
Michael A. Galgano, MD,
Mijung Lee, MD,
Timothy E. Richardson, DO, PhD,
Kavya Mirchia, MD

Affiliations

Sultan M. Zain, MPH: College of Medicine, State University of New York, Upstate Medical University, Syracuse, NY 13210, USA; Corresponding author.
Kanish Mirchia, MD: Department of Pathology, State University of New York, Upstate Medical University, Syracuse, NY 13210, USA
Kristyn Galbraith, MD: Department of Pathology, State University of New York, Upstate Medical University, Syracuse, NY 13210, USA; Department of Pathology, New York University Langone Health, New York City, NY 10016, USA
Michael A. Galgano, MD: Department of Neurosurgery, State University of New York, Upstate Medical University, Syracuse, NY 13210, USA
Mijung Lee, MD: Department of Internal Medicine, Division of Hematology Oncology, State University of New York, Upstate Medical University, Syracuse, NY 13210, USA
Timothy E. Richardson, DO, PhD: Department of Pathology, State University of New York, Upstate Medical University, Syracuse, NY 13210, USA; Department of Pathology and Laboratory Medicine, University of Texas Health San Antonio, San Antonio, TX 78229, USA; Glenn Biggs Institute for Alzheimer's & Neurodegenerative Diseases, University of Texas Health San Antonio, San Antonio, TX 78229, USA
Kavya Mirchia, MD: Department of Radiology, State University of New York, Upstate Medical University, Syracuse, NY 13210, USA

Journal volume & issue: Vol. 17, no. 9
pp. 3339 – 3344

Abstract

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ABSTRACT: Primary intracranial germ cell tumors are rare, occurring more frequently in children and young adults in midline locations of the brain. Teratomas are an uncommon variant of germ cell neoplasm, although they account for a high proportion of fetal brain tumors. Here, we report a 27-year-old male who presented with a heterogeneously enhancing lesion in the left thalamus, without evidence of systemic disease. Histologic and immunohistochemical analysis were consistent with immature teratoma; next-generation sequencing was negative for targetable molecular alterations. The patient received chemotherapy and radiotherapy post-excision. Following the initial resection, ventriculoperitoneal shunt placement was performed due to left temporal horn entrapment. Nine months later, imaging revealed mediastinal and hilar adenopathy as well as pleural disease, with encasement and compression of pulmonary vasculature, and multiple, bilateral pulmonary nodules. Fine needle aspiration showed malignant cells with an immunohistochemical profile similar to the original tumor, consistent with metastases. Though germ cell tumors are known to spread via cerebrospinal fluid or blood, metastasis outside of the CNS from a primary intracranial germ cell tumor is a rare complication. Spread via ventriculoperitoneal shunt, which may have occurred in the present case, has also rarely been observed.

Published in Radiology Case Reports

ISSN: 1930-0433 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Medicine (General): Medical physics. Medical radiology. Nuclear medicine
Website: http://www.journals.elsevier.com/radiology-case-reports/

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