The External Metastasis of The Central Nerve Yystem Germ Cell Tumors: Case Report and Review of Literature

Background: The central nervous system germ cell tumors (CNS GCTs) represent a class of rare tumors with incidences ranging from 3.6% in North America to 15.3% in some areas of Asia, and commonly occurring in children and adolescents[1]. According to the 2016 World Health Organization (WHO) classification, GCTs divided into germinomas, non-germinal germ cell tumors (NGGCT) and suprasellar with male prominent[2]. Common symptoms of GCTs include headache, dizziness, vomiting, thirst, heavy drinking, and precocious puberty[3]. Because of GCTs arising in the pineal region could compress the interventricular foramen with consequence obstructive hydrocephalus, leading to high intracranial pressure (HIP), the ventriculoperitoneal shunt is preferred to relieve severe HIP. Although CNS GCTs tend to spread through the subependymal lining and cerebrospinal fluid (CSF), the metastasis along the ventriculoperitoneal shunt is extremely rare[4]. Therefore, we reported two cases and a review of the literature.