{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T17:03:12Z","timestamp":1787590992725,"version":"build-2736575974"},"reference-count":70,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"2","license":[{"start":{"date-parts":[[2024,7,8]],"date-time":"2024-07-08T00:00:00Z","timestamp":1720396800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Cosmet Laser Ther"],"published-print":{"date-parts":[[2024,7,8]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Metachronous intracranial germ cell tumors (iGCTs)\u2014unrelated, histologically different iGCTs occurring at different time points\u2014occurring within the same patient remain a rarity. Herein, the authors report such a case and discuss the literature and potential pathophysiological mechanisms leading to this phenomenon.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBSERVATIONS<\/jats:title>\n                    <jats:p>A 9-year-old boy presented with new-onset impaired balance, headaches, nausea, visual disturbances, and left facial paresis. Magnetic resonance imaging (MRI) scans revealed a suspected pineal region teratoma originating from the pineal gland with consecutive obstructive hydrocephalus. A mature teratoma was diagnosed and resected. Postoperative recovery was good, and the patient could return to his normal daily activities. However, a new, slowly progressive lesion in the sellar region with an enlarged infundibular stalk was detected on follow-up MRI 3.5 years after initial pineal region teratoma resection. Biopsy revealed a newly developed pure germinoma. The patient was treated with radiotherapy plus chemotherapy and remained relapse free at the last follow-up. Sixteen other cases have reported a surgically resected primary mature teratoma, wherein patients developed metachronous germinomas during follow-up. Different theories try to elaborate this phenomenon, yet none can completely account for it.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>LESSONS<\/jats:title>\n                    <jats:p>Although rare, metachronous iGCT is a phenomenon neurosurgeons should be aware of. In patients treated for iGCT, close long-term clinical, imaging, and laboratory follow-up is recommended.<\/jats:p>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/thejns.org\/doi\/10.3171\/CASE2443\">https:\/\/thejns.org\/doi\/10.3171\/CASE2443<\/jats:ext-link>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/case2443","type":"journal-article","created":{"date-parts":[[2024,7,8]],"date-time":"2024-07-08T02:49:45Z","timestamp":1720406985000},"source":"Crossref","is-referenced-by-count":2,"title":["Pituitary germinoma after resection of a mature third ventricular teratoma: illustrative case"],"prefix":"10.3171","volume":"8","author":[{"given":"Tim J","family":"Hallenberger","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, University Hospital Basel, Basel, Switzerland"},{"name":"Faculty of Medicine, University of Basel, Basel, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emma","family":"von Seth","sequence":"additional","affiliation":[{"name":"Division of Pediatric Neurosurgery, Children\u2019s University Hospital Basel, Basel, Switzerland"},{"name":"School of Neuroscience, King\u2019s College London, London, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michel","family":"Roethlisberger","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University Hospital Basel, Basel, Switzerland"},{"name":"Faculty of Medicine, University of Basel, Basel, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raphael","family":"Guzman","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University Hospital Basel, Basel, Switzerland"},{"name":"Division of Pediatric Neurosurgery, Children\u2019s University Hospital Basel, Basel, Switzerland"},{"name":"Faculty of Medicine, University of Basel, Basel, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jehuda","family":"Soleman","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University Hospital Basel, Basel, Switzerland"},{"name":"Division of Pediatric Neurosurgery, Children\u2019s University Hospital Basel, Basel, Switzerland"},{"name":"Faculty of Medicine, University of Basel, Basel, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"6","key":"bib1","series-title":"Oncologist","first-page":"690","article-title":"Pediatric central nervous system germ cell tumors: a review","volume":"13","author":"Echevarr\u00eda","year":"2008","unstructured":"Echevarr\u00eda MEFangusaro JGoldman S. Pediatric central nervous system germ cell tumors: a review. Oncologist. 2008;13(6):690-699."},{"issue":"2","key":"bib2","series-title":"J Neurosurg","first-page":"155","article-title":"Intracranial germ-cell tumors: natural history and pathogenesis","volume":"63","author":"Jennings","year":"1985","unstructured":"Jennings MTGelman RHochberg F. Intracranial germ-cell tumors: natural history and pathogenesis. J Neurosurg. 1985;63(2):155-167."},{"issue":"8","key":"bib3","series-title":"Neuro Oncol","first-page":"1389","article-title":"Outcomes of intracranial germinoma\u2013a retrospective multinational Asian study on effect of clinical presentation and differential treatment strategies","volume":"24","author":"Koh","year":"2022","unstructured":"Koh KNWong RXLee DE, et al. Outcomes of intracranial germinoma\u2013a retrospective multinational Asian study on effect of clinical presentation and differential treatment strategies. Neuro Oncol. 2022;24(8):1389-1399."},{"issue":"2","key":"bib4","series-title":"Childs Nerv Syst","first-page":"359","article-title":"Histogenesis of intracranial germ cell tumors: primordial germ cell vs. embryonic stem cell","volume":"39","author":"Burnham","year":"2023","unstructured":"Burnham ELTomita T. Histogenesis of intracranial germ cell tumors: primordial germ cell vs. embryonic stem cell. Childs Nerv Syst. 2023;39(2):359-368."},{"issue":"9","key":"bib5","series-title":"No To Shinkei","first-page":"893","article-title":"Development of 2 cell pattern pinealoma 15 years after total removal of pineal teratoma","volume":"28","author":"Tsuchida","year":"1976","unstructured":"Tsuchida TTanaka RKobayashi KUeki KKoizumi R. Development of 2 cell pattern pinealoma 15 years after total removal of pineal teratoma. No To Shinkei. 1976;28(9):893-899."},{"issue":"4","key":"bib6","series-title":"Childs Brain","first-page":"230","article-title":"Dissemination with malignant changes from a pineal tumor through the corpus callosum after total removal","volume":"3","author":"Carrillo","year":"1977","unstructured":"Carrillo RRicoy JRDel Pozo JMGarc\u00eda-Uria JHerrero J. Dissemination with malignant changes from a pineal tumor through the corpus callosum after total removal. Childs Brain. 1977;3(4):230-237."},{"issue":"11","key":"bib7","series-title":"No To Shinkei","first-page":"1107","article-title":"Problems on recurrence after removal of teratoma in pineal region--an experience of recurrence of pineal teratoma 4 years after tumor removal","volume":"34","author":"Matsuda","year":"1982","unstructured":"Matsuda KMaeda YKodama S, et al. [Problems on recurrence after removal of teratoma in pineal region--an experience of recurrence of pineal teratoma 4 years after tumor removal]. No To Shinkei. 1982;34(11):1107-1115."},{"issue":"5","key":"bib8","series-title":"Surg Neurol","first-page":"481","article-title":"Suprasellar germinoma occurring two years after total removal of pineal teratoma","volume":"22","author":"Nagasawa","year":"1984","unstructured":"Nagasawa SHanda HYamashita JYamamura K. Suprasellar germinoma occurring two years after total removal of pineal teratoma. Surg Neurol. 1984;22(5):481-485."},{"issue":"2","key":"bib9","series-title":"Br J Ophthalmol","first-page":"111","article-title":"Congenital orbital-intracranial teratoma with subsequent malignancy: case report","volume":"70","author":"Garden","year":"1986","unstructured":"Garden JWMcManis JC. Congenital orbital-intracranial teratoma with subsequent malignancy: case report. Br J Ophthalmol. 1986;70(2):111-113."},{"issue":"6","key":"bib10","series-title":"Surg Neurol","first-page":"462","article-title":"A case of malignant teratoma developing from the septum pellucidum 7 years after removal of a mature teratoma in the pineal region","volume":"30","author":"Kamiya","year":"1988","unstructured":"Kamiya KInagawa TOgasawara H. A case of malignant teratoma developing from the septum pellucidum 7 years after removal of a mature teratoma in the pineal region. Surg Neurol. 1988;30(6):462-467."},{"issue":"4","key":"bib11","series-title":"J Neurosurg","first-page":"643","article-title":"Third ventricle germinoma after total removal of intrasellar teratoma. Case report","volume":"77","author":"Czirj\u00e1k","year":"1992","unstructured":"Czirj\u00e1k SP\u00e1sztor ESlowik FSzeifert G. Third ventricle germinoma after total removal of intrasellar teratoma. Case report. J Neurosurg. 1992;77(4):643-647."},{"issue":"2","key":"bib12","series-title":"Surg Neurol","first-page":"205","article-title":"Metachronous neurohypophyseal germinoma occurring 8 years after total resection of pineal mature teratoma","volume":"49","author":"Ikeda","year":"1998","unstructured":"Ikeda JSawamura YKato TAbe H. Metachronous neurohypophyseal germinoma occurring 8 years after total resection of pineal mature teratoma. Surg Neurol. 1998;49(2):205-209."},{"issue":"2","key":"bib13","series-title":"J Neurosurg","first-page":"364","article-title":"Intrathecal and intraperitoneal germinomas occurring 20 years after total removal of a pineal teratoma. Case report","volume":"96","author":"Iwamuro","year":"2002","unstructured":"Iwamuro YSeo SHirose Y, et al. Intrathecal and intraperitoneal germinomas occurring 20 years after total removal of a pineal teratoma. Case report. 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Neurosurgery. 2002;50(3):613-617."},{"issue":"6","key":"bib16","series-title":"J Neurosurg","first-page":"1067","article-title":"Malignant transformation of intracranial mature teratoma to yolk sac tumor after late relapse. Case report","volume":"106","author":"Utsuki","year":"2007","unstructured":"Utsuki SOka HSagiuchi TShimizu SSuzuki SFujii K. Malignant transformation of intracranial mature teratoma to yolk sac tumor after late relapse. Case report. J Neurosurg. 2007;106(6):1067-1069."},{"issue":"2","key":"bib17","series-title":"J Neurooncol","first-page":"217","article-title":"Occurrence of a germinoma 22 years after resection of a mature cerebral teratoma","volume":"88","author":"Janzarik","year":"2008","unstructured":"Janzarik WGM\u00fcller KL\u00fcbbert M, et al. Occurrence of a germinoma 22 years after resection of a mature cerebral teratoma. J Neurooncol. 2008;88(2):217-219."},{"issue":"8","key":"bib18","series-title":"Eur J Pediatr","first-page":"1011","article-title":"Successful treatment of metastatic \u03b2HCG-secreting germ cell tumor occurring 3 years after total resection of a pineal mature teratoma","volume":"173","author":"Cardellicchio","year":"2014","unstructured":"Cardellicchio SFarina SBuccoliero AM, et al. Successful treatment of metastatic \u03b2HCG-secreting germ cell tumor occurring 3 years after total resection of a pineal mature teratoma. Eur J Pediatr. 2014;173(8):1011-1015."},{"issue":"1","key":"bib19","series-title":"Neurol Med Chir (Tokyo)","first-page":"51","article-title":"Extremely late recurrence 21 years after total removal of immature teratoma: a case report and literature review","volume":"57","author":"Mano","year":"2017","unstructured":"Mano YKanamori MKumabe T, et al. Extremely late recurrence 21 years after total removal of immature teratoma: a case report and literature review. 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Acta Pathol Microbiol Scand. 1965;64(4):407-429."},{"issue":"3","key":"bib24","series-title":"Cells Tissues Organs","first-page":"201","article-title":"The development of the thalamus","volume":"9","author":"Cooper","year":"1950","unstructured":"Cooper ER. The development of the thalamus. Cells Tissues Organs. 1950;9(3):201-226."},{"issue":"1","key":"bib25","series-title":"Cancer Genet Cytogenet","first-page":"96","article-title":"Chromosomal constitution and developmental potential of human germ cell tumors and teratomas","volume":"95","author":"Oosterhuis","year":"1997","unstructured":"Oosterhuis JWLooijenga LHvan Echten Jde Jong B. Chromosomal constitution and developmental potential of human germ cell tumors and teratomas. 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Semin Cell Dev Biol. 2020;100:152-159."},{"issue":"3","key":"bib28","series-title":"Br J Neurosurg","first-page":"391","article-title":"So-called intracranial germ cell tumours: are they really of germ cell origin?","volume":"9","author":"Sano","year":"1995","unstructured":"Sano K. So-called intracranial germ cell tumours: are they really of germ cell origin?Br J Neurosurg. 1995;9(3):391-402."},{"issue":"6","key":"bib29","series-title":"Neuropathol Appl Neurobiol","first-page":"569","article-title":"Are cranial germ cell tumours really tumours of germ cells?","volume":"32","author":"Scotting","year":"2006","unstructured":"Scotting PJ. Are cranial germ cell tumours really tumours of germ cells?Neuropathol Appl Neurobiol. 2006;32(6):569-574."},{"issue":"10-11):","key":"bib30","series-title":"Int J Dev Biol","first-page":"337","article-title":"Teratomas produced from human pluripotent stem cells xenografted into immunodeficient mice - a histopathology atlas","volume":"60","author":"Damjanov","year":"2016","unstructured":"Damjanov IAndrews PW. Teratomas produced from human pluripotent stem cells xenografted into immunodeficient mice - a histopathology atlas. Int J Dev Biol. 2016;60(10-11):337-419. ."},{"issue":"4","key":"bib31","series-title":"Neuro Oncol","first-page":"516","article-title":"EANO, SNO and Euracan consensus review on the current management and future development of intracranial germ cell tumors in adolescents and young adults","volume":"24","author":"Frappaz","year":"2022","unstructured":"Frappaz DDhall GMurray MJ, et al. EANO, SNO and Euracan consensus review on the current management and future development of intracranial germ cell tumors in adolescents and young adults. Neuro Oncol. 2022;24(4):516-527."},{"issue":"4","key":"bib32","series-title":"Children (Basel)","first-page":"501","article-title":"Transitional care in pediatric brain tumor patients: a systematic literature review","volume":"9","author":"Ebel","year":"2022","unstructured":"Ebel FGreuter LGuzman RSoleman J. Transitional care in pediatric brain tumor patients: a systematic literature review. Children (Basel). 2022;9(4): 501."},{"issue":"14","key":"bib33","series-title":"Cancers","first-page":"3555","article-title":"Evaluation of the perioperative and postoperative course of surgery for pineal germinoma in the SIOP CNS GCT 96 trial","volume":"14","author":"Shabo","year":"2022","unstructured":"Shabo ECzech TNicholson JC, et al. 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J Neurosurg Pediatr. 2013;11(6):704-709."},{"issue":"6","key":"bib1","series-title":"Oncologist","first-page":"690","article-title":"Pediatric central nervous system germ cell tumors: a review","volume":"13","author":"Echevarr\u00eda","year":"2008","unstructured":"Echevarr\u00eda MEFangusaro JGoldman S. Pediatric central nervous system germ cell tumors: a review. Oncologist. 2008;13(6):690-699."},{"issue":"2","key":"bib2","series-title":"J Neurosurg","first-page":"155","article-title":"Intracranial germ-cell tumors: natural history and pathogenesis","volume":"63","author":"Jennings","year":"1985","unstructured":"Jennings MTGelman RHochberg F. Intracranial germ-cell tumors: natural history and pathogenesis. J Neurosurg. 1985;63(2):155-167."},{"issue":"8","key":"bib3","series-title":"Neuro Oncol","first-page":"1389","article-title":"Outcomes of intracranial germinoma\u2013a retrospective multinational Asian study on effect of clinical presentation and differential treatment strategies","volume":"24","author":"Koh","year":"2022","unstructured":"Koh KNWong RXLee DE, et al. Outcomes of intracranial germinoma\u2013a retrospective multinational Asian study on effect of clinical presentation and differential treatment strategies. Neuro Oncol. 2022;24(8):1389-1399."},{"issue":"2","key":"bib4","series-title":"Childs Nerv Syst","first-page":"359","article-title":"Histogenesis of intracranial germ cell tumors: primordial germ cell vs. embryonic stem cell","volume":"39","author":"Burnham","year":"2023","unstructured":"Burnham ELTomita T. Histogenesis of intracranial germ cell tumors: primordial germ cell vs. embryonic stem cell. Childs Nerv Syst. 2023;39(2):359-368."},{"issue":"9","key":"bib5","series-title":"No To Shinkei","first-page":"893","article-title":"Development of 2 cell pattern pinealoma 15 years after total removal of pineal teratoma","volume":"28","author":"Tsuchida","year":"1976","unstructured":"Tsuchida TTanaka RKobayashi KUeki KKoizumi R. Development of 2 cell pattern pinealoma 15 years after total removal of pineal teratoma. No To Shinkei. 1976;28(9):893-899."},{"issue":"4","key":"bib6","series-title":"Childs Brain","first-page":"230","article-title":"Dissemination with malignant changes from a pineal tumor through the corpus callosum after total removal","volume":"3","author":"Carrillo","year":"1977","unstructured":"Carrillo RRicoy JRDel Pozo JMGarc\u00eda-Uria JHerrero J. Dissemination with malignant changes from a pineal tumor through the corpus callosum after total removal. Childs Brain. 1977;3(4):230-237."},{"issue":"11","key":"bib7","series-title":"No To Shinkei","first-page":"1107","article-title":"Problems on recurrence after removal of teratoma in pineal region--an experience of recurrence of pineal teratoma 4 years after tumor removal","volume":"34","author":"Matsuda","year":"1982","unstructured":"Matsuda KMaeda YKodama S, et al. [Problems on recurrence after removal of teratoma in pineal region--an experience of recurrence of pineal teratoma 4 years after tumor removal]. No To Shinkei. 1982;34(11):1107-1115."},{"issue":"5","key":"bib8","series-title":"Surg Neurol","first-page":"481","article-title":"Suprasellar germinoma occurring two years after total removal of pineal teratoma","volume":"22","author":"Nagasawa","year":"1984","unstructured":"Nagasawa SHanda HYamashita JYamamura K. Suprasellar germinoma occurring two years after total removal of pineal teratoma. 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Surg Neurol. 1998;49(2):205-209."},{"issue":"2","key":"bib13","series-title":"J Neurosurg","first-page":"364","article-title":"Intrathecal and intraperitoneal germinomas occurring 20 years after total removal of a pineal teratoma. Case report","volume":"96","author":"Iwamuro","year":"2002","unstructured":"Iwamuro YSeo SHirose Y, et al. Intrathecal and intraperitoneal germinomas occurring 20 years after total removal of a pineal teratoma. Case report. J Neurosurg. 2002;96(2):364-367."},{"issue":"2","key":"bib14","series-title":"J Korean Med Sci","first-page":"287","article-title":"Metachronous germinoma after total removal of mature teratoma in the third ventricle: a case report","volume":"17","author":"Kim","year":"2002","unstructured":"Kim JMCheong JHYi HJBak KHKim CHOh SJ. Metachronous germinoma after total removal of mature teratoma in the third ventricle: a case report. J Korean Med Sci. 2002;17(2):287-291."},{"issue":"3","key":"bib15","series-title":"Neurosurgery","first-page":"613","article-title":"Bilateral metachronous germinoma of the basal ganglia occurring long after total removal of a mature pineal teratoma: case report","volume":"50","author":"Sugimoto","year":"2002","unstructured":"Sugimoto KNakahara INishikawa M. Bilateral metachronous germinoma of the basal ganglia occurring long after total removal of a mature pineal teratoma: case report. Neurosurgery. 2002;50(3):613-617."},{"issue":"6","key":"bib16","series-title":"J Neurosurg","first-page":"1067","article-title":"Malignant transformation of intracranial mature teratoma to yolk sac tumor after late relapse. Case report","volume":"106","author":"Utsuki","year":"2007","unstructured":"Utsuki SOka HSagiuchi TShimizu SSuzuki SFujii K. Malignant transformation of intracranial mature teratoma to yolk sac tumor after late relapse. Case report. J Neurosurg. 2007;106(6):1067-1069."},{"issue":"2","key":"bib17","series-title":"J Neurooncol","first-page":"217","article-title":"Occurrence of a germinoma 22 years after resection of a mature cerebral teratoma","volume":"88","author":"Janzarik","year":"2008","unstructured":"Janzarik WGM\u00fcller KL\u00fcbbert M, et al. Occurrence of a germinoma 22 years after resection of a mature cerebral teratoma. J Neurooncol. 2008;88(2):217-219."},{"issue":"8","key":"bib18","series-title":"Eur J Pediatr","first-page":"1011","article-title":"Successful treatment of metastatic \u03b2HCG-secreting germ cell tumor occurring 3 years after total resection of a pineal mature teratoma","volume":"173","author":"Cardellicchio","year":"2014","unstructured":"Cardellicchio SFarina SBuccoliero AM, et al. Successful treatment of metastatic \u03b2HCG-secreting germ cell tumor occurring 3 years after total resection of a pineal mature teratoma. Eur J Pediatr. 2014;173(8):1011-1015."},{"issue":"1","key":"bib19","series-title":"Neurol Med Chir (Tokyo)","first-page":"51","article-title":"Extremely late recurrence 21 years after total removal of immature teratoma: a case report and literature review","volume":"57","author":"Mano","year":"2017","unstructured":"Mano YKanamori MKumabe T, et al. Extremely late recurrence 21 years after total removal of immature teratoma: a case report and literature review. Neurol Med Chir (Tokyo). 2017;57(1):51-56."},{"issue":"12","key":"bib20","series-title":"Childs Nerv Syst","first-page":"2423","article-title":"Pure germinoma occurring 11 years after total pineal mature teratoma removal: a case report and review of the literature","volume":"35","author":"Sakakura","year":"2019","unstructured":"Sakakura KMuroi ATsurubuchi TTakano SIshikawa EMatsumura A. Pure germinoma occurring 11 years after total pineal mature teratoma removal: a case report and review of the literature. 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