CASE REPORT
Os tumores de células germinativas intracranianos, especialmente germinomas, predominam em crianças do sexo masculino e acometem preferencialmente a glândula pineal. Este artigo descreve o caso de um paciente adulto com germinoma pineal, destacando o manejo da hidrocefalia, o tratamento oncológico multimodal e os desafios associados à recidiva tumoral. Paciente masculino, 21 anos, apresentou cefaleia, vômitos e fotofobia, evoluindo com Síndrome de Parinaud e hidrocefalia obstrutiva secundária a lesão pineal. Tomografia e ressonância magnética confirmaram tumor de células germinativas, posteriormente diagnosticado como germinoma. O manejo inicial incluiu derivação ventrículo-peritoneal e ressecção subtotal da lesão, seguidas de quimioterapia e radioterapia, com resposta clínica inicial satisfatória. Após recidiva, o paciente foi submetido a novas intervenções cirúrgicas, incluindo tentativa de terceiroventriculostomia endoscópica sem sucesso, derivação ventricular externa e ressecção macroscópica posterior, além de quimioterapia paliativa. O diagnóstico precoce depende da integração de sinais clínicos, exames de imagem e marcadores séricos, como beta-HCG, e o estadiamento via líquor é essencial para detectar disseminação tumoral. O manejo da hidrocefalia deve priorizar técnicas menos invasivas, evitando derivação ventrículo-peritoneal quando possível. Este relato evidencia a complexidade do manejo dos germinomas pineais, reforçando a necessidade de condutas precoces, individualizadas e multimodais para otimizar o prognóstico e minimizar complicações.
Intracranial germ cell tumors, especially germinomas, predominate in male children and preferentially affect the pineal gland. This article describes the case of an adult patient with pineal germinoma, highlighting the management of hydrocephalus, multimodal oncological treatment, and the challenges associated with tumor recurrence. A 21-year-old male patient presented with headache, vomiting, and photophobia, progressing to Parinaud syndrome and obstructive hydrocephalus secondary to a pineal lesion. Computed tomography and magnetic resonance imaging confirmed a germ cell tumor, later diagnosed as a germinoma. Initial management included ventriculoperitoneal shunting and subtotal resection of the lesion, followed by chemotherapy and radiotherapy, with a satisfactory initial clinical response. After recurrence, the patient underwent further surgical interventions, including an unsuccessful attempt at endoscopic third ventriculostomy, external ventricular shunting, and posterior macroscopic resection, in addition to palliative chemotherapy. Early diagnosis depends on the integration of clinical signs, imaging tests, and serum markers, such as beta-HCG, and staging via cerebrospinal fluid is essential to detect tumor spread. The management of hydrocephalus should prioritize less invasive techniques, avoiding ventriculoperitoneal shunting when possible. This report highlights the complexity of managing pineal germinomas, reinforcing the need for early, individualized, and multimodal approaches to optimize prognosis and minimize complications.
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1School of Medicine, University of Western São Paulo, Presidente Prudente, SP, Brazil.
2Department of Neurological Surgery, Hospital Regional de Presidente Prudente, Presidente Prudente, SP, Brazil.
Received Aug 31, 2025
Accepted Oct 21, 2025
