{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T07:23:22Z","timestamp":1787556202143,"version":"build-2736575974"},"reference-count":29,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T00:00:00Z","timestamp":1786060800000},"content-version":"vor","delay-in-days":6,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Neuropathology"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Central nervous system germ cell tumors are uncommon and include germinomas, teratomas, and other nongerminomatous germ cell tumors. Mature teratomas are usually cured by complete resection, but rare patients later develop a histologically distinct malignant germ cell tumor. We report a man who presented at age 20\u2009years with a cystic pineal lesion. Gross\u2010total resection at age 21\u2009years showed a mature teratoma with bronchogenic differentiation and no overt immature or malignant component on H&amp;E. Serial postoperative MRI for 3\u2009years showed no recurrence. Eleven years after surgery, he developed headache, gait disturbance, and confusion due to a 4.6\u2010cm pineal mass with obstructive hydrocephalus. Serum alpha\u2010fetoprotein was normal, whereas beta\u2010human chorionic gonadotropin (\u03b2\u2010hCG) was elevated. The resected tumor showed sheets of large round cells with clear cytoplasm and dense lymphocytes. Immunohistochemistry demonstrated strong nuclear OCT4 and SALL4 and membranous c\u2010KIT, with focal \u03b2\u2010hCG\u2010positive syncytiotrophoblastic giant cells. No nongerminomatous germ cell tumor component was identified, supporting a diagnosis of germinoma with focal syncytiotrophoblastic giant cells. After this diagnosis, retrospective evaluation of the initial tumor showed multifocal, patchy OCT4 immunoreactivity in scattered cells along the ciliated respiratory\u2010type epithelial lining. SALL4, c\u2010KIT, and PLAP were focally positive in corresponding regions. These findings raised the possibility of an occult germ cell marker\u2010positive population, although no discrete expansile germinoma component was identified. This case illustrates that metachronous germinoma can develop after a long disease\u2010free interval following resection of a mature teratoma and highlights the value of retrospective pathologic evaluation and long\u2010term surveillance.<\/jats:p>","DOI":"10.1111\/neup.70073","type":"journal-article","created":{"date-parts":[[2026,8,8]],"date-time":"2026-08-08T04:26:43Z","timestamp":1786163203000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Metachronous Pineal Germinoma 11\u2009Years After Total Resection of a Mature Teratoma"],"prefix":"10.1111","volume":"46","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8868-9700","authenticated-orcid":false,"given":"Shunsuke","family":"Koga","sequence":"first","affiliation":[{"name":"Department of Pathology and Laboratory Medicine Hospital of the University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ilya M.","family":"Nasrallah","sequence":"additional","affiliation":[{"name":"Department of Radiology Hospital of the University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel","family":"Blue","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Hospital of the University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan Pablo","family":"Ospina","sequence":"additional","affiliation":[{"name":"Department of Neurology Hospital of the University of Pennsylvania  Philadelphia Pennsylvania USA"},{"name":"Division of Hematology Oncology, Department of Medicine Hospital of the University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5803-8920","authenticated-orcid":false,"given":"Steven","family":"Brem","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Hospital of the University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason","family":"Shpilsky","sequence":"additional","affiliation":[{"name":"Division of Hematology Oncology, Department of Medicine Hospital of the University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4861-0898","authenticated-orcid":false,"given":"MacLean","family":"Nasrallah","sequence":"additional","affiliation":[{"name":"Department of Pathology and Laboratory Medicine Hospital of the University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9852-1845","authenticated-orcid":false,"given":"Zissimos","family":"Mourelatos","sequence":"additional","affiliation":[{"name":"Department of Pathology and Laboratory Medicine Hospital of the University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,7]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1634\/theoncologist.2008-0037"},{"key":"e_1_2_10_3_1","volume-title":"Central Nervous System Tumours","author":"WHO Classification of Tumours Editorial 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