Delayed intra-tumoural haemorrhage in pineal germinoma: Case report and review


Intraparenchymal haemorrhage in a pineal germinoma is a very rare, though clinically significant event. We report the first case of a significantly delayed intraparenchymal haemorrhage in a pineal germinoma, 14 days after endoscopic third ventriculostomy (ETV), causing precipitous patient deterioration. We discuss potential contributing pathophysiological factors, and seek to illustrate that knowledge of its occurrence, and associated morbidity, is clinically significant in managing pineal germinoma patients with acute deterioration post obstructive hydrocephalus CSF diversion.

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Colditz, M. and Winter, C. (2013) Delayed intra-tumoural haemorrhage in pineal germinoma: Case report and review. World Journal of Neuroscience, 3, 186-189. doi: 10.4236/wjns.2013.33023.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Srinivasan, N., PA, Mukkamalla, C. and Oswal, A. (2010) Pineal germinoma. Southern Medical Journal, 103, 1031-1037. doi:10.1097/SMJ.0b013e3181ebeeff
[2] Clark, A., Sughrue, M.E., Ivan, M., Aranda, D., Rutkowski, M., Kane, A., Chang, S. and Parsa, A. (2010) Factors influencing overall survival rates for patients with pineocytoma. Journal of Neuro-Oncology, 100, 255-260. doi:10.1007/s11060-010-0189-6
[3] Bouras, T. and Sgouros, S. (2011) Complications of endoscopic third ventriculostomy. Journal of Neurosurgery: Pediatrics, 7, 643-649. doi:10.3171/2011.4.PEDS10503
[4] Cipri, S., Gangemi, A., Cafarelli, F., Messina, G., Iacopino, P., Al Sayyad, S., Capua, A., Comi, M. and Musitano, A. (2005) Neuroendoscopic management of hydrocephalus secondary to midline and pineal lesions. Journal of Neurosurgical Sciences, 49, 97-106.
[5] O’Brien, D.F., Hayhurst, C., Pizer, B. and Mallucci, C.L. (2005) Outcomes in patients undergoing single-trajectory endoscopic third ventriculostomy and endoscopic biopsy for midline tumors presenting with obstructive hydrocephalus. Journal of Neurosurgery, 105, 219-226.
[6] Sacko, O., Boetto, S., Lauwers-Cances, V., Dupuy, M. and Roux, F.E. (2010) Endoscopic third ventriculostomy: Outcome analysis in 368 procedures. Journal of Neurosurgery: Pediatrics, 5, 68-74. doi:10.3171/2009.8.PEDS08108
[7] Hayashi, N., Murai, H., Ishihara, S., Kitamura, T., Miki, T., Miwa, T., Miyajima, M., Nishiyama, K., Ohira, T., Ono, S., Suzuki, T., Takano, S., Date, I., Saeki, N. and Endo, S. (2011) Nationwide investigation of the current status of therapeutic neuroendoscopy for ventricular and paraventricular tumors in Japan. Journal of Neurosurgery, 115, 1147-1157. doi:10.3171/2011.7.JNS101976
[8] Harada, K., Hayashi, T., Anegawa, S., Torigoe, R., Maeda, K., Toda, K., Sugita, Y. and Utsunomiya, H. (1993) Pineocytoma with intratumoral hemorrhage following ventriculoperitoneal shunt—Case report. Neurologia Medico-Chirurgica (Tokyo), 33, 836-838. doi:10.2176/nmc.33.836
[9] Wong, T.T., Yen, S.H., Ho, D.M., Chang, F.C. and Chang, K.P. (2003) Pineal germinoma with intratumoral hemorrhage after neuroendoscopic tumor biopsy. Child’s Nervous System, 19, 769-772. doi:10.1007/s00381-003-0800-7
[10] Matsumoto, K., Imaoka, T., Tomita, S. and Ohmoto, T. (1997) Pineocytoma with massic intratumoral hemorrhage after ventriculoperitoneal shunt. Neurologia Medico-Chirurgica (Tokyo), 37, 911-915. doi:10.2176/nmc.37.911
[11] Waga, S., Shimizu, T., Shimosaka, S. and Tochio, H. (1981) Intratumoral hemorrhage after a ventriculoperitoneal shunting procedure. Neurosurgery, 9, 249-252. doi:10.1227/00006123-198109000-00005
[12] Salunke, P., Sharma, M. and Bhardwaj, L. (2011) Bleed and Herniation in tumors compressing the ventricular system: perils of preoperative CSF diversion. Journal of Neurosurgical Anesthesiology, 23, 268-270. doi:10.1097/ANA.0b013e31821b9d95
[13] Murata, T., Shigeta, H., Sato, A., Tanaka, Y. and Hongo, K. (2006) Intratumoral hemorrhage in choriocarcinoma during neuroendoscopic third ventriculostomy: Case report. No Shinkei Geka. Neurological Surgery, 4, 305-310.
[14] Vaquero, J., Cabezudo, J.M., De Solo, R.G. and Nombela, L. (1981) Intratumoral hemorrhage in posterior fossa tumors after ventricular drainage: Report of two cases. Journal of Neurosurgery, 54, 406-408. doi:10.3171/jns.1981.54.3.0406
[15] Santhanam, R., Balasubramaniam, A. and Chandramouli, B.A. (2009) Fatal intratumoral hemorrhage in posterior fossa tumors following ventriculoperitoneal shunt. Journal of Clinical Neuroscience, 16, 135-137. doi:10.1016/j.jocn.2008.02.016
[16] Kasliwal, M.K., Agrawal, D. and Sharma, B.S. (2008) Fatal intratumoral hemorrhage following ventriculo-peritoneal shunt. Turkish Neurosurgery, 18, 436-438.
[17] Schroeder, H.W., Niendorf, W.R., Schwesinger, G. and Gaab, M.R. (1995) Fatal tumor hemorrhage after ventriculoperitoneal shunting. Case report. Neuropediatrics, 26, 177-179. doi:10.1055/s-2007-979750
[18] Zuccarello, M., Dollo, C. and Carollo, C. (1985) Spontaneous intratumoral hemorrhage after ventriculoperitoneal shunting. Neurosurgery, 16, 245-246. doi:10.1227/00006123-198502000-00024
[19] Epstein, F. and Murali, R. (1978) Pediatric posterior fossa tumors: Hazards of the “preoperative” shunt. Neurosurgery, 3, 348-350. doi:10.1227/00006123-197811000-00003
[20] Singha, S.K., Chatterjee, N. and Neema, P.K. (2009) Reverse herniation of brain: A less recognized complication in a patient with midline posterior fossa tumor postendoscopic third ventriculostomy. Journal of Neurosurgical Anesthesiology, 21, 354-355. doi:10.1097/ANA.0b013e3181ac8edb
[21] Hung, Y.C., Lee, E.J., Wang, L.C., Chen, H.H., Yan, J.J. and Yu, C.Y. (1999) Mixed germ cell tumor presenting as intratumoral hemorrhage: Report of a case originated from the pineal region. The Kaohsiung Journal of Medical Sciences, 15, 498-503.
[22] Hata, N., Inamura, T., Matsushima, T., Yoshimoto, K., Ikezaki, K., Nakamizo, A., Inoha, S. and Fukui, M. (2002) A case of pineoblastoma primary presenting a pineal hemorrhage causing obstructive hydrocephalus. No Shinkei Geka. Neurological Surgery, 30, 65-70.
[23] Steinbok, P., Dolman, C.L. and Kaan, K. (1977) Pineocytomas presenting as subarachnoid hemorrhage: Report of two cases. Journal of Neurosurgery, 47, 776-780.
[24] Kondziolka, D., Bernstein, M., Resch, L., Tator, C.H., Fleming, J.F.R., Vanderlinden, R.G. and Schutz, H. (1987) Significance of hemorrhage into brain tumors: Clinicopathological study. Journal of Neurosurgery, 67, 852-857. doi:10.3171/jns.1987.67.6.0852

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