Abstract
Pineal Germinomas are rare tumors comprising approximately less than one percent of brain tumors seen mostly in children or young adults and in males. Its recurrence is even more rare especially with local recurrence or leptomeningeal dissemination which is around 15%. We report a case of a 25 year old female which initially presents as frontal headache with associated photophobia and doubling of vision. Persistence of symptoms prompted consult upon which an MRI was done revealing a mass lesion. Surgical biopsy was done with histopathology revealing germinoma. Four cycles of chemotherapy and one session of radiotherapy were done. Serial MRI showed regression in size and complete resolution of the initial symptoms hence patient was able to return to work. One month thereafter, patient had sudden onset left sided weakness hence readmission. Radiation Necrosis and Pineal Germinoma Recurrence were entertained. MRI perfusion revealed interval increase of the intracranial mass. Additionally, MRI of the whole spine with contrast revealed Multifocal intradural mass on the cervical, lumbar and sacral region upon which surgical removal was done. Histopathology revealed Germinoma. The patient was then also started on corticosteroid therapy and eventual Partial Laminectomy. After which, radiation therapy and other treatment modalities were also considered. Hence, in this paper, we aim to report an extremely rare case of Pineal Germinoma with recurrence and distant metastasis in a Female Adult Filipino and to provide novel insight on the treatment modalities for Pineal Germinoma Recurrence.