[Pineal choriocarcinoma presenting massive ventricular hemorrhage--a case report].

A case of primary choriocarcinoma in the pineal region is reported. A six-year-old boy showing precocious puberty, suddenly developed coma by massive ventricular hemorrhage. He recovered gradually up to akinetic mutism, but whose clinical, hormonal and neuroradiological studies failed to demonstrate any pathological lesions. Four years later a small tumor was detected by CT in the pineal region. At the same time increased serum-HCG level was shown. Subtotal removal of the tumor was carried out by Stein's supracerebellar infratentorial approach. The pathology of the tumor showed the characteristics of choriocarcinoma, consisting of major necrotic area and of tumor cells, syncytiotrophoblast and cellular trophoblast. The former revealed strong activity of HCG by immunoperoxidase study. Postoperative chemotherapy with actinomycin-D and methotrexate was given for a month. In the course of these treatments, serum-HCG recovered within normal range. This patient shows no signs and symptoms of the recurrence 6 months after operation. Early diagnosis with aids of neuroradiology as well as hormonal studies and the early initiation of the treatment may prevent major complications like massive tumoral bleeding, also might achieve the favorable outcome of this tumor.