Abstract
Germ cell tumors (GCTs) commonly develop in the pineal and suprasellar regions, with the most common GCTs being germinomas. In this report, a 22-year-old male presented with progressive right-sided weakness, and his imaging was consistent with a left thalamic high-grade glioma. A stereotactic biopsy was performed, revealing a germinoma, but radiation therapy was not done, and the patient was lost to follow-up. He was readmitted due to ulcerative tumor growth at the previous skin incision, and imaging revealed tumor progression with implantation metastasis along the track of the previous biopsy. The scalp lesion and tumor through the burr hole were excised, and histopathologic studies confirmed that it was a proliferation of the previous germinoma. He was discharged well but was unfortunately unable to follow up at the clinic. Thalamic germinomas are difficult to diagnose and treat because of their rarity. Here, we underscore the importance of careful patient selection, precise biopsy techniques, thorough postoperative management, and close radiographic surveillance to minimize the risk of implantation metastasis and promptly treat it if it occurs.