Primary pontomedullary germinoma in a 12 year old boy.

Primary intracranial germinomas are rare tumors, accounting for approximately 1-4% of all intracranial tumors. Intracranial germinomas are more commonly found in the suprasellar and pineal midline structures of the brain. Brainstem and posterior fossa germinomas are rarer still, with few reported cases in the literature, and little discussion of their presentation, management and clinical outcome. A unique case of pontomedullary germinoma, diagnosed in a 12-year-old boy, is described. Only six previous cases of lower brainstem germinoma have been reported, with varying modes of presentation and a lack of definitive management guidelines. Of these, all occurred in either females or a patient with Klinefelter's syndrome. We report the first case of a lower brainstem germinoma in a male without known genetic abnormality. Tumor remission was achieved with partial surgical resection, chemotherapy and radiotherapy.

Spontaneous regression of low-grade gliomas in pediatric patients without neurofibromatosis.

OBJECTIVE: Pediatric low-grade gliomas comprise a diverse range of central nervous system tumors, sharing the usual course of a slow progression in growth. In individual cases however, the natural history can be variable, and rarely spontaneous regression has been described. This paper describes factors associated with spontaneous regression. METHODS: A literature review was performed to identify factors associated with spontaneous regression. A unique case is described to contribute to the findings. RESULTS: Low-grade gliomas occurring in association with neurofibromatosis are more likely to spontaneously regress. Only 14 cases of spontaneous regression of low-grade gliomas in patients without neurofibromatosis have been described, and of these, the vast majority regress in association with optic chiasm gliomas. We describe the first documented case of spontaneous regression of a temporal lobe pilocytic astrocytoma in a patient without neurofibromatosis. CONCLUSION: Spontaneous regression of low-grade gliomas can occur for tumors in a diversity of anatomical locations, at varying ages and in both sexes. This may have implications for management. As such, spontaneous tumor regression is an important outcome to be considered for pediatric low-grade gliomas and pilocytic astrocytomas.

Spontaneous involution of two sinus pericranii - a unique case and review of the literature.

Sinus pericranii is a rare vascular anomaly in which an abnormal communication exists between the extracranial venous system and the dural venous sinuses. The natural history is of increasing size and potential life-threatening complications, including thrombosis and haemorrhage. Thus surgical management is the mainstay of treatment. We present a unique case of spontaneous involution of two sinus pericranii in a 1-year-old patient, the second reported case of spontaneous involution in the literature, and the first in which regression occurred at such a young age. The clinical, diagnostic and management options are discussed.