Coexistence of an intracranial germ cell tumor with a growing arteriovenous fistula: a case report.

08:00 EDT 6th April 2019 | BioPortfolio

Summary of "Coexistence of an intracranial germ cell tumor with a growing arteriovenous fistula: a case report."

A 26-year-old man was admitted with complaints of progressive depressive mood and general fatigue. Magnetic resonance imaging (MRI) revealed diffuse enhanced lesions in the neurohypophyseal, pineal, and paraventricular regions and ventricular wall. Endoscopic biopsy confirmed the presence of germ cell tumor (GCTs), and chemoradiation therapy (CRT) was then performed. Most of the tumors disappeared after CRT except for the right paraventricular lesion. Follow-up MRI performed 14 months after CRT showed enlargement of this residual lesion. In addition to tumor growth, coexistent flow void signals within the tumor increased. Angiographically, this vascular lesion mimicked arteriovenous malformation (AVM), which was mainly fed by the lenticulostriate artery (LSA) and drained into the internal cerebral vein. Transarterial embolization was performed, resulting in effective flow reduction. Subsequently, the tumor was resected without complications. It was histopathologically diagnosed as mature teratoma with arteriovenous fistula (AVF). Arterial components were observed to directly connect to venous components within the tumor without any intermediate nidal components. To the best of our knowledge, this is the first reported case of an intracranial GCT coexistent with a growing AVF. AVF developed within a CRT-refractory teratomatous component, which was successfully treated with embolization followed by surgical resection.


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Name: World neurosurgery
ISSN: 1878-8769


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Medical and Biotech [MESH] Definitions

An unusual and aggressive tumor of germ-cell origin that reproduces the extraembryonic structures of the early embryo. It is the most common malignant germ cell tumor found in children. It is characterized by a labyrinthine glandular pattern of flat epithelial cells and rounded papillary processes with a central capillary (Schiller-Duval body). The tumor is rarely bilateral. Before the use of combination chemotherapy, the tumor was almost invariably fatal. (From DeVita Jr et al., Cancer: Principles & Practice of Oncology, 3d ed, p1189)

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Congenital vascular anomalies in the brain characterized by direct communication between an artery and a vein without passing through the CAPILLARIES. The locations and size of the shunts determine the symptoms including HEADACHES; SEIZURES; STROKE; INTRACRANIAL HEMORRHAGES; mass effect; and vascular steal effect.

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The process of germ cell development in the female from the primordial germ cells through OOGONIA to the mature haploid ova (OVUM).

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