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Pediatr Blood Cancer 2020 Jul 19;67(7):e28407. Epub 2020 May 19.

Children & Young People's Unit, The Royal Marsden NHS Foundation Trust, London, UK.

Little is known about pseudoprogression in brain tumours other than gliomas. A 9-year-old male child with a pineal teratoma/germinoma underwent surgical resection followed by adjuvant chemo-radiotherapy. The magnetic resonance imaging scan 4 months post-radiotherapy showed a contrast-enhancing lesion within the surgical cavity suspicious of recurrence. Read More

Medicine (Baltimore) 2019 Aug;98(34):e16652

Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing, China.

Introduction: Tumors of the pineal region are rare, and metastatic carcinoma occurring in the pineal region is extremely rare. No previous reports have described pineal region metastasis with intraventricular seeding.

Patient Concerns: We report a case of a 51-year-old woman presented with a 1-week history of severe headache, nausea, and vomiting. Read More

NMC Case Rep J 2019 Aug 11;6(3):75-78. Epub 2019 Jun 11.

Department of Neurosurgery, Brain Research Institute, Niigata University, Niigata, Niigata, Japan.

Germ cell tumors typically occur in children and adolescents. We here report a rare case of pineal region germinoma in the seventh decade of life. A 62-year-old man presented with double vision. Read More

Neuroendocrinology 2020 4;110(5):422-429. Epub 2019 Jul 4.

Department of Endocrinology, Post Graduate Institute of Medical Education and Research, Chandigarh, India,

Germinomas are highly immunogenic tumors eliciting a strong peri-tumoral immune response that can spillover into the surrounding healthy tissues. This phenomenon can also occur in intracranial germinomas, manifesting as secondary hypophysitis. Herein, we report a case of 12-year-old-girl presenting with polyuria and polydispsia. Read More

Malays J Pathol 2019 Apr;41(1):71-73

National University of Malaysia, Department of Pathology, 56000 Kuala Lumpur, Malaysia.

Introduction: Intratumoral calcification is a feature that is more often observed in pineal parenchymal tumour than germinoma. We describe a 13-year-old male with pineal region germinoma demonstrating extensive intratumoral calcification.

Case Report: He presented with worsening headache that was associated with fatigue, nausea and vomiting. Read More

Childs Nerv Syst 2019 09 22;35(9):1615-1619. Epub 2019 Feb 22.

Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan.

Primary intracranial germinoma is a rare central nervous system tumor that usually arises in the pineal and the supra-sellar region. Here, we report a rare case of primary intracavernous sinus germinoma with an atypical extension pattern, with a comparison to germinomas originating from the cavernous sinus as described in the existing literature. A 12-year-old boy was admitted to our hospital with the chief complaint of the left-side ptosis and double vision. Read More

Endocrinol Diabetes Metab Case Rep 2019 Feb 7;2019. Epub 2019 Feb 7.

Department of Endocrinology, Diabetes and Metabolism.

Intracranial germinomas are rare tumors affecting mostly patients at young age. Therefore, molecular data on its etiopathogenesis are scarce. We present a clinical case of a male patient of 25 years with an intracranial germinoma and a 16p11. Read More

Br J Neurosurg 2018 Nov 19:1-8. Epub 2018 Nov 19.

a Department of Neurosurgery , West China Hospital, Sichuan University , Chengdu , Sichuan 610041 , China.

Background: Intracranial germinomas are uncommon and constitute less than 1% of all intracranial tumors. They usually arise in the midline of the brain, most commonly in the pineal region. Pineal germinomas tend to spread through the cerebrospinal fluid (CSF). Read More

Endokrynol Pol 2018 ;69(5):612-618

Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Centre of Serbia, Belgrade, Serbia, Serbia and Montenegro; University of Belgrade, School of Medicine, Belgrade, Serbia.

Background: Intracranial germinomas (ICG) are uncommon brain neoplasms with extremely rare familial occurance. Since ICG invades hypothalamus and/or pituitary, the endocrine dysfunction is one of the common determinants of these tumors. We presented two brothers with the history of ICG. Read More

Am J Ophthalmol Case Rep 2018 Sep 19;11:142-145. Epub 2018 Jul 19.

Department of Surgery, Division of Ophthalmology, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, Japan.

Purpose: To report a rare case of bilateral periphlebitis associated with a pineal germinoma.

Observations: A 17-year-old male teenager presented at a local clinic complaining of blurred vision in both eyes. The treating physician identified bilateral uveitis, and prescribed the patient with a local steroid treatment. Read More

World Neurosurg 2018 Sep 15;117:165-171. Epub 2018 Jun 15.

Pathology Institute of Passo Fundo, Passo Fundo, Brazil.

Background: Germinomas are rare malignant central nervous system tumors, a type of germ cell tumor, according to the 2016 World Health Organization Classification of Brain Tumors. Most of these tumors develop along the midline, most often from the pineal gland, followed by tumors arising in the suprasellar cisterns. Suprasellar germinomas commonly manifest with diabetes insipidus, visual impairment, and hypothalamic-pituitary failure. Read More

Asian J Neurosurg 2018 Apr-Jun;13(2):492-495

Department of Neurosurgery, SGPGIMS, Lucknow, Uttar Pradesh, India.

Germ cell tumors (GCTs) are rare intracranial tumors with a strong predilection for children. Commonly, these tumors arise either in the suprasellar or the pineal region. The basal ganglia-thalamus complex represents a rare site of nonmidline intracranial GCTs. Read More

World Neurosurg 2018 Apr 20;112:e84-e94. Epub 2017 Dec 20.

Department of Neurosurgery, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan.

Background: The differentiation of germinoma from other tumors by conventional magnetic resonance imaging (MRI) can be very difficult. The purpose of our study was to determine whether diffusion-weighted imaging (DWI) and single-voxel proton magnetic resonance spectroscopy (1H-MRS) could provide additional useful information for a definitive diagnosis of germinomas.

Methods: Our hospital's Institutional Review Board approved this retrospective study. Read More

J Neuroophthalmol 2018 Jun;38(2):198-199

Departments of Ophthalmology and Visual Sciences (SYS), The University of Chicago, Chicago, Illinois; Department of Ophthalmology (SYS), Dean McGee Eye Institute, University of Oklahoma, Oklahoma City, Oklahoma; Department of Neurology (JHP), NorthShore University Health System, Glenview, Ilinois; Departments of Ophthalmology and Visual Sciences (SK), NorthShore University Health System, Glenview, Illinois; and Department of Pathology (JML), NorthShore University Health System, Evanston, Illinois.

Neuroradiology 2018 Jan 23;60(1):27-34. Epub 2017 Sep 23.

Imaging Department, Institut Curie, 26 rue d'Ulm, 75005, Paris, France.

Purpose: The current staging system of central nervous system (CNS) germ cell tumors (GCT) includes a binary classification in "localized" or "metastatic" disease based on the absence or presence of leptomeningeal dissemination. Loco-regional tumor dissemination has been barely described whereas its accurate definition might be useful in terms of prognosis and treatment, especially for radiation therapy planning. Our purpose was therefore to describe MR patterns and prevalence of loco-regional extensions of these tumors. Read More

World Neurosurg 2017 Dec 24;108:939-947.e1. Epub 2017 Aug 24.

Department of Neurosurgery, University Hospital Münster, Münster, Germany.

Background: Tumors arising from the pineal region account for approximately 1% of intracranial neoplasms. We present a case of a previously healthy 5-year-old boy with an acute onset of headache. A magnetic resonance imaging (MRI) scan showed a pineal mass with aqueduct compression. Read More

World Neurosurg 2017 Nov 24;107:974-982. Epub 2017 Jul 24.

Division of Neurosurgery, Department of Surgery, Université de Sherbrooke, Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Québec, Canada. Electronic address:

Background: Pineal region tumors represent a rare and histologically diverse group of lesions. Few studies are available to guide management and the outcomes after stereotactic radiosurgery (SRS).

Methods: Patients who underwent SRS for a pineal region tumor and for whom at least 6 months of imaging follow-up was available were retrospectively assessed in 5 centers. Read More

World Neurosurg 2017 Oct 12;106:430-434. Epub 2017 Jul 12.

Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.

Objective: A neuroendoscopic biopsy has become common for the diagnosis of ventricular tumors. However, its utility in patients with germ cell tumors (GCTs) has not been well discussed. We examined the usefulness and pitfalls of neuroendoscopic biopsies of intraventricular GCTs at a single institution. Read More

J Neurooncol 2017 Aug 27;134(1):221-230. Epub 2017 May 27.

Department of Neurosurgery, Taipei Medical University Hospital, Taipei, Taiwan, ROC.

Intracranial germ cell tumors differ in histology and location, and require different clinical management strategies. We characterized the imaging features that may aid pre-operative differentiation of intracranial germinomas and non-germinomatous germ cell tumors (NGGCTs). This retrospective study analyzed 85 patients with intracranial germ cell tumors and adequate preoperative or pretreatment MRIs between 2000 and 2013 at our institution. Read More

J Neurooncol 2017 Aug 20;134(1):119-124. Epub 2017 May 20.

Department of Neurosurgery, Kansai Medical University Hospital, 2-5-1 Shinmachi, Hirakata, Osaka, 573-1010, Japan.

5-Aminolevulinic acid (5-ALA) fluorescence-guided surgery is widely used for detection and planning of resection of malignant gliomas and other brain tumors. However, no reports have described 5-ALA fluorescence-guided surgery or direct visualization of germ cell tumors. Here, we report two cases of germ cell tumors in which a positive 5-ALA fluorescent signal was visualized with a neuroendoscope. Read More

Pediatr Blood Cancer 2017 Oct 24;64(10). Epub 2017 Apr 24.

Department of Radiotherapy, Institut d'Hématologie et d'Oncologie Pédiatrique, Centre Léon Bérard, Lyon, France.

Objective: Patients with brain tumors often report having visual complaints. This may be due to increased intracranial pressure, compression/invasion of the optic pathway or diplopia. We assessed the incidence and the etiology of visual symptoms in patients with intracranial germinoma tumors (ICGTs). Read More

Neurosurg Rev 2018 Jan 1;41(1):197-206. Epub 2017 Mar 1.

Department of Neurosurgery, Ehime University School of Medicine, 454 Shitsukawa, Toon, Ehime, 791-0295, Japan.

The aim of the study is to identify characteristic features of pineal germinoma that enhance preoperative accuracy in differentiating germinoma from other pineal region tumors. Twenty-one consecutive patients with pineal region tumors were enrolled. In all patients, tumor resection was performed to verify the histology. Read More

Childs Nerv Syst 2017 May 24;33(5):859-863. Epub 2017 Feb 24.

Department of Pathology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, 60611, USA.

Introduction: Intracranial teratomas are rare germ cell neoplasms that contain tissues derived from all three germ cell layers and most commonly occurring during childhood. This is the first report of pineal region mixed mature teratoma and germinoma in two fraternal brothers of fraternal triplets.

Case Presentation: We report the case of a mixed mature teratoma and germinoma of the pineal region in two brothers of fraternal triplets. Read More

Rom J Morphol Embryol 2016 ;57(3):1045-1050

"Fundeni" Urological Surgery Discipline, 3rd Department, Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, Center for Uronephrology and Renal Transplantation, "Fundeni" Clinical Institute, Bucharest, Romania;

Introduction: Retroperitoneal seminoma is a very rare form of cancer, with embryological origin represented by primordial germ cells from the urogenital ridges left behind during the fetal development. Extragenital germ cell tumors can also occur in the mediastinum or the pineal gland. The aim of this paper is to outline the particularities and draw embryological, histopatological and treatment conclusions regarding extragonadal germ cell tumors. Read More

Neurol Med Chir (Tokyo) 2017 Jan 7;57(1):51-56. Epub 2016 Dec 7.

Department of Neurosurgery, Tohoku University Graduate School of Medicine.

Immature teratoma (IMT) is normally treated by resection and adjuvant therapy. The present unusual case of recurrent germinoma occurred 21 years after total resection of pineal IMT. A 3-year-old boy presented with headache, disturbance of consciousness, and Parinaud's syndrome. Read More

Pediatr Neurosurg 2017 11;52(2):87-92. Epub 2016 Nov 11.

Department of Neurosurgery, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Niigata, Japan.

We present a pediatric case of neurohypophyseal germinoma with a perifocal inflammatory reaction (PIR) with volume fluctuation caused by diagnostic radiation-induced regression (DRIR). On-target biopsy failed to confirm the histology because PIR hardly contained any germinoma cells. DRIR-related fluctuation of the tumor volume disguised germinoma as inflammation. Read More

J Neurosurg Sci 2018 Apr 22;62(2):228-229. Epub 2016 Sep 22.

Department of Clinical Neurosciences, Neurosurgical Service, Faculty of Biology and Medicine, University Hospital of Lausanne (CHUV), Lausanne, Switzerland.

Turk Neurosurg 2018 ;28(1):29-35

Bakirkoy Research and Training Hospital for Neurology Neurosurgery and Psychiatry, Department of Neurosurgery, Istanbul, Turkey.

Aim: Primary intracranial germinomas (PIGs) are rare malignant brain tumors that represent approximately 0.2% to 1.7% of all primary intracranial tumors. Read More

World Neurosurg 2016 Nov 23;95:625.e1-625.e5. Epub 2016 Aug 23.

Department of Neurosurgery, Hospitales Universitarios Virgen del Rocio, Seville, Spain. Electronic address:

Background: The accurate histologic diagnosis of germ cell tumors in the pineal region is a keystone for determining the best treatment strategy and prognosis. This situation poses a challenge for the neuropathologist, considering the lack of a standarized procedure to obtain biopsy samples, which results in few and small specimens, which are not suitable for diagnosis.

Case Description: We report a case in which a pineal region mixed germ cell tumor was accurately diagnosed by performing histologic mapping through a dual burr-hole endoscopic approach. Read More

J Clin Neurosci 2016 Dec 28;34:151-157. Epub 2016 Jul 28.

Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China.

Whether bifocal germinomas (BFGs) synchronously presenting within the pineal region and the hypothalamo-neurohypophyseal axis (HNA) are primary germinomas of dual-origin remains to be elucidated. We analyzed MRI images and clinical features of 95 neurohypophyseal germinomas and 21 BFG patients and developed a tentative definition of the BFGs. We found dual-primary BFGs (true BFGs) do exist. Read More

Cureus 2016 Jun 15;8(6):e643. Epub 2016 Jun 15.

Neurosurgery, University of Illinois College of Medicine at Peoria.

A 19-year-old Caucasian male presented with complaints of headaches and syncope. Suspicion of hydrocephalus prompted computed tomography (CT) and magnetic resonance imaging (MRI), which revealed pineal and suprasellar prominences with diffuse, thick, nodular subependymal enhancement of the lateral and third ventricles. Based on imaging, the differential diagnosis consisted primarily of malignancy, such as lymphoma, with inflammatory and infectious etiologies not excluded. Read More

World Neurosurg 2016 Dec 7;96:124-128. Epub 2016 Jun 7.

Neurosurgical Clinic, Goethe-University Frankfurt, Frankfurt, Germany.

Background: Stereotactic biopsies are carried out to obtain tumor tissue of unknown entity from cerebral lesions. Thus, tumor tissue can be examined, resulting in correct diagnosis and treatment. These procedures go in hand with high accuracy, high diagnostic yield, and low complication rates. Read More

Brain Tumor Res Treat 2016 Apr 29;4(1):26-9. Epub 2016 Apr 29.

Center for Pediatric Cancer, National Cancer Center, Goyang, Korea.

Langerhans cell histiocytosis (LCH) has diverse clinical manifestations, including intracranial mass lesions. We report a case of LCH that manifested as a suprasellar mass, and initially misdiagnosed as a germ cell tumor. A 29-year-old woman presented with polyuria, polydipsia and amenorrhea. Read More

J Clin Neurosci 2016 Sep 2;31:192-5. Epub 2016 Apr 2.

Department of Diagnostic Radiology, Yale School of Medicine, Box 208042, Tompkins East 2, 333 Cedar Street, New Haven, CT 06520-8042, USA. Electronic address:

Intracranial ectopic germinomas are often associated with synchronous midline disease. Germinomas involving the corpus callosum are exceedingly rare. The reported imaging appearance is not as varied as one might expect and a review of the literature reveals a few common imaging features amongst most ectopic lesions, including cyst formation. Read More

Arch Soc Esp Oftalmol 2016 Jul 18;91(7):341-5. Epub 2016 Feb 18.

Servicio de Radiodiagnóstico, Hospital Universitario Central de Asturias, Oviedo, Asturias, España.

Clinical Case: A 33-year-old male diagnosed with Parinaud's syndrome, exotropia and post-papillary oedema optic atrophy in his left eye. A pineal germinoma was diagnosed after performing neuroimaging scans and a stereotactic biopsy. He was treated with chemotherapy and radiotherapy, showing a complete pathological response. Read More

J Neurooncol 2016 Mar 7;127(1):173-80. Epub 2016 Jan 7.

Department of Paediatrics, University of Toronto, Toronto, ON, Canada.

CNS germinomas have an excellent prognosis with radiation therapy alone. However, in children, volume and dose of CNS radiation are associated with neurocognitive and neuroendocrine sequelae. Our objective was to determine long-term outcomes of our cohort who received chemotherapy and reduced radiation. Read More

Oncol Lett 2015 Aug 10;10(2):1194-1196. Epub 2015 Jun 10.

Department of Radiology, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, Shandong 264100, P.R. China.

Intracranial germinomas (IG) are rare tumors that typically occur in the pineal gland and suprasellar region of the brain. IG can be successfully treated with radiation therapy and its recurrence is rare. The present study reports the case of a patient with IG involving the pineal and suprasellar regions. Read More

J Neurol Sci 2015 Nov 28;358(1-2):512-4. Epub 2015 Sep 28.

Geriatrics Research Institute and Hospital, 3-26-8 Otomo-machi, Maebashi, Gunma 371-0847, Japan. Electronic address:

Clin Neurol Neurosurg 2015 Dec 9;139:62-5. Epub 2015 Sep 9.

Department of Neurosurgery, Cantonal Hospital St. Gallen, Rorschacher Str. 95, 9007 St. Gallen, Switzerland. Electronic address:

We report a clinical case of a 19-year-old male patient who developed pure word deafness due to the local compressive effect of a pineal germinoma on the inferior colliculi of the quadrigeminal plate. After percutaneous radiation therapy the size of the tumor decreased significantly, while audiometry demonstrated a complete regression of the auditory deficit. Since pure word deafness is commonly attributed to temporal lesions, the inferior colliculi represent an exceptional site for these symptoms. Read More

Med Mol Morphol 2017 Mar 27;50(1):52-58. Epub 2015 May 27.

Department of Pathology, Fujieda Municipal General Hospital, Shizuoka, Japan.

Intracranial germinomas comprise 0.5-2.0 % of all central nervous system (CNS) tumors and 50-60 % of CNS germ cell tumors. Read More

Neuroradiol J 2015 Apr 11;28(2):209-16. Epub 2015 May 11.

Department of Neurosurgery, University of Tennessee Health Science Center, USA Le Bonheur Neuroscience Institute, Le Bonheur Children's Hospital, USA Semmes-Murphey Neurologic and Spine Institute, USA Division of Neurosurgery, St Jude Children's Hospital, USA.

Background: Diffusion weighted imaging (DWI) has been shown to be helpful in characterizing tumor cellularity, and predicting histology. Several works have evaluated this technique for pineal tumors; however studies to date have not focused on pediatric pineal tumors.

Objective: We evaluated the diffusion characteristics of pediatric pineal tumors to confirm if patterns seen in studies using mixed pediatric and adult populations remain valid. Read More

J Pediatr Neurosci 2015 Jan-Mar;10(1):38-40

Department of Neurosurgery, Sri Aurobindo Institute of Medical Sciences and P.G. Institute, Indore, Madhya Pradesh, India.

Synchronous intracranial germ cell tumor in the pineal and suprasellar region is rare. They represent only 5-10% of all intracranial germinomas. They are also known by the entity "double midline atypical teratoma" and are common in the second decade of life. Read More

Pediatr Int 2015 Jun 24;57(3):483-6. Epub 2015 Feb 24.

Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, Hidaka, Japan.

We report the case of a 19-year-old woman with a highly malignant intracranial germ cell tumor (GCT) that developed 14 years after treatment for neurohypophyseal germinoma. Magnetic resonance imaging (MRI) showed a large neurohypophyseal mass and a synchronous lesion in the pineal region. Plasma α-fetoprotein was elevated to 3038 ng/mL. Read More

J Neuroophthalmol 2015 Jun;35(2):171-4

Departments of Neurological Surgery (NSC, FUA, JJM) and The Miami Project to Cure Paralysis, Pathology (EW), and Ophthalmology (NS), University of Miami Miller School of Medicine, Miami, Florida.

Intracranial germinomas are typically present in the suprasellar or pineal location, and their origin within the optic nerve or chiasm is extremely rare. We report a 25-year-old woman with an exophytic primary optic chiasm germinoma who underwent partial resection followed by radiation and had no detectable tumor on magnetic resonance imaging at 1-year follow-up. Read More

Childs Nerv Syst 2015 Jun 11;31(6):953-8. Epub 2015 Jan 11.

Department of Neurosurgery, Shizuoka Children's Hospital, 860 Urushiyama, Aoi-ku, Shizuoka, 420-8660, Japan,

Purpose: Here, we report a case of pediatric germinoma located in the bilateral basal ganglia, which presented with severe cognitive deteriorations.

Case Report: A 15-year-old boy presented with decreased school performance and mild cognitive disturbances. Magnetic resonance images (MRI) of the brain revealed T2 hyperintensity in the bilateral basal ganglia. Read More

Zhonghua Wai Ke Za Zhi 2014 Aug;52(8):584-8

Department of Neurosurgery, Chinese People's Liberation Army General Hospital, Beijing 100853, China.

Objective: To evaluate and explore the optimal surgical strategy for the normalized treatment of pineal region tumors.

Methods: From September 2007 to February 2012, 43 patients were treated in Chinese People's Liberation Army General Hospital, including 30 male and 14 female patients, with pineal region tumors and non-communicating hydrocephalus were enrolled, who were 1-52 years old, mean age was (27 ± 4) years. The clinical records, treatment strategy, and prognosis were retrospectively analyzed. Read More

Psychosomatics 2014 Nov-Dec;55(6):729-34. Epub 2014 May 6.

Department of Psychiatry, Harbor-UCLA Medical Center, David-Geffen School of Medicine, University of California, Los Angeles, CA.

Interv Neuroradiol 2014 Jul-Aug;20(4):448-53. Epub 2014 Aug 28.

Department of Neurosurgery, Eisyokai Yoshida Hospital; Kobe, Japan.

Radiation-induced cerebral aneurysms are rare. We describe a case of radiation-induced cerebral aneurysm successfully treated with endovascular coil embolization. A 39-year-old man received 60 Gy of radiation to a pineal germinoma at eight years old. Read More

No Shinkei Geka 2014 Sep;42(9):859-65

Department of Neurosurgery, Kawasaki Medical School.

This report describes a mixed germ cell tumor that underwent dramatic size changes. A 12-year-old boy presented to our hospital with a headache that had persisted for two months. Initial magnetic resonance imaging (MRI) revealed a pineal tumor and hydrocephalus. Read More

J Neurosurg Pediatr 2014 Oct 25;14(4):348-55. Epub 2014 Jul 25.

Department of Pediatrics, Division of Hematology-Oncology.

The authors describe a series of 15 intracranial germ cell tumors (IGCTs) excluding mature teratomas; 3 cases in children younger than 3 years of age who were treated at 3 different international institutions over the course of 20 years, and 12 from a PubMed search. These tumors, with possible in utero origins, often occur in atypical locations. The clinical behavior differed significantly from these tumors' counterparts in older children. Read More