Intracranial endodermal sinus tumors associated with growth hormone replacement therapy in a girl

Case report

Zhiwei Tang M.D.1, Xiang'en Shi M.D., Ph.D.1, K. I. Singh Khatri Chhetri M.B.B.S.2, and Xueling Qi M.D.3
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  • 1 Department of Neurosurgery, Fu Xing Hospital, Capital Medical University, Beijing;
  • | 2 Department of Neurosurgery, First Affiliated Hospital of Liaoning Medical University, Jinzhou; and
  • | 3 Department of Pathology, Beijing Sanbo Brain Institute, Beijing, People's Republic of China
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The primary intracranial endodermal sinus tumor (EST) is regarded as a rare histological subtype that is often associated with components of other germ cell tumors, and there are no reports on the onset of intracranial ESTs after growth hormone (GH) replacement therapy. The authors report an extremely rare case of pure primary EST associated with GH replacement therapy. A 15-year-old girl with GH deficiency experienced headache, nausea, and vomiting after GH replacement therapy for a 17-month period. Magnetic resonance imaging showed 2 tumor masses located in the pineal region and frontal horn of the right lateral ventricle, respectively. Before surgery, the authors administered 1 cycle of neoadjuvant chemotherapy, which shrank the tumor and facilitated surgical intervention. The larger mass located in the pineal region was removed via a right occipital transtentorial approach, and postoperative histopathological analysis revealed a pure EST. While there is a clear association between the initiation of GH replacement therapy and the development of the EST in this case, the causal effect cannot be specified. Nevertheless, this case demonstrates that GH replacement therapy must be used cautiously.

Abbreviations used in this paper:

AFP = α-fetoprotein; EST = endodermal sinus tumor; GH = growth hormone; IFG-I = insulin-like growth factor–I.

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Contributor Notes

Address correspondence to: Xiang'en Shi, M.D., Ph.D., Department of Neurosurgery, Fu Xing Hospital, Capital Medical University, No. 20 Fu Xing Menwai Street, Xicheng District, Beijing 100038, People's Republic of China. email: shixen@sina.com.

Please include this information when citing this paper: DOI: 10.3171/2011.10.PEDS1195.

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