ISOLATED CNS METASTASIS AS THE 1ST SITE OF RECURRENCE IN A CHILD WITHGERM-CELL TUMOR OF THE MEDIASTINUM

We describe a 2-year-old black female who was previously in complete r emission from a stage 4 mediastinal germ cell tumor (stage 4 because o f a single pulmonary parenchymal lesion). She presented with headaches , obtundation, and brain herniation, and suffered sudden death 12 mont hs after completing high-dose chemotherapy. Autospy revealed a large i ntraventricular lesion with mixed germ cell tumor elements, but no oth er evidence of malignancy was found. This case represents the first re port of isolated CNS metastasis of malignant germ cell tumor in a chil d in apparent remission without evidence of advanced or recurrent dise ase in other sites. It is possible that the aggressive chemotherapy us ed resulted in a change in the natural history of this disorder. (C) 1 995 Wiley-Liss, Inc.