A 23-year-old man with history of hepatic abscess complicated by portal vein thrombus and secondary splenomegaly being treated with warfarin presented in early June 2018 with headache, blurry vision, and fatigue. Head CT and gadolinium-enhanced MRI revealed a left thalamic mass with compression of the cerebral aqueduct, requiring an immediate ventriculoperitoneal shunt for obstructive hydrocephalus. He was discharged and re-presented in late June 2018 with worsening encephalopathy, Parinaud’s syndrome, and secondary Parkinsonism. A stereotactic biopsy was performed with pathology showing a NGGCT with yolk sac component. His serum and cerebrospinal fluid AFP were 1011 ng/ml and 677.9 ng/ml, respectively, an increase from 115.8 ng/ml and 0.6 ng/ml in early June. He was initiated on six alternating cycles of carboplatin/etoposide and etoposide/ifosfamide, with an appropriate decrease in AFP and tumor size. The patient’s clinical course was complicated initially by shunt malfunction and hydrocephalus, requiring repeated ventriculostomies, which later resolved when the tumor responded to treatment. He also received carbidopa-levodopa for secondary Parkinsonism and intensive rehabilitation to regain his motor functions.

This case demonstrates positive response of a pineal region NGGCT to alternating cycles of carboplatin/etoposide and ifosfamide/etoposide in a young adult. Complications that developed include obstructive hydrocephalus, Parinaud’s syndrome, and secondary Parkinsonism, which can all be addressed with appropriate interventions.