NCMP-04. IMPLANTATION METASTASIS FOLLOWING BIOPSY OF THALAMIC GERMINOMA – A CASE REPORT AND REVIEW OF LITERATURE

Abstract Germ cell tumors commonly develop in the pineal and suprasellar regions, with the most common germ cell tumor being germinomas. In this report, a 22-year-old male presented with progressive right-sided weakness and his imaging was consistent a thalamic high grade glioma. A stereotactic biopsy was performed, revealing a germinoma, but radiation therapy was not done and patient was lost to follow up. He was readmitted due to ulcerative tumor growth at the previous skin incision, and imaging revealed tumor progression with implantation metastasis along the tract of the previous biopsy. The scalp tumor was excised and histopathologic studies confirmed that it was proliferation of the previous germinoma. He was discharged well but was unfortunately unable to follow up at the clinic. Thalamic germinomas are difficult to diagnose and treat because of their rarity. Here we underscore the importance of careful patient selection, precise biopsy techniques, thorough postoperative management and close radiographic surveillance to minimize the risk of implantation metastasis and promptly treat it if it occurs.