Germ cell tumors of the thalamus and the basal ganglia

Abstract

Two cases of germ cell tumors (GCTs) of the basal ganglia are presented and 40 previously reported cases are reviewed. The incidence of GCTs of the basal ganglia and thalamus was estimated as less than 14% of all intracranial GCTs. All patients except for two (95%) were male, aged 7-19 years. The clinical course was usually slow. The major symptoms were hemiparesis, mental deterioration such as dementia or character change, precocious puberty, diabetes insipidus, oculomotor palsy, speech disturbance, and hemianopsia. Signs of intracranial hypertension did not occur until the late stages of the disease. The plain CT finding was characterized by an irregularly defined, slightly high-density area frequently accompanied by central low-density areas without significant mass effect. The tumors showed mild to moderate and nonhomogeneous contrast enhancement. An ipsilateral cerebral hemiatrophy was often found. MR images demonstrated the corresponding findings. GCTs of the basal ganglia had a high possibility of containing components other than germinoma such as choriocarcinoma, endodermal sinus tumor, and embryonal carcinoma. Thus, tumor markers in the serum, CSF, or cyst fluid were frequently positive. With recent refinement of microsurgical techniques as well as immunohistochemical study and measurements of tumor markers of serum, CSF, and cyst fluid, major resections of tumor, accurate pretreatment histologic diagnosis, and early determination of the specific types of this tumor appear to be readily possible. This is essential for effective treatment of patients not only with radiosensitive germinoma, but also those with radioinsensitive nongerminoma variants and a combination of them located in this region.

Intracranial Germinoma Presenting With Hemiatrophy- Follow-up Results and Literature Review -Two Case Reports-

“…17,18) The most common symptoms in these patients were hemiparesis and cognitive dysfunction, which are nonspecific signs of involvement of subcortical structures. Only 4 patients without suprasellar lesions on MR imaging manifested diabetes insipidus, a possible clue for a preoperative diagnosis of germinoma.…”

“…5,6) Some basal ganglia germinomas are associated with hemispheric atrophy. 5,[7][8][9]11,15,17,19) The neuroimaging findings are usually subtle in the early stage and clinical manifestations are not specific, so diagnosis of germinoma in these regions is not easy. 1,5,7,15) We report 2 cases of germinoma in which the first magnetic resonance (MR) imaging revealed hemispheric atrophy that included the basal ganglia and follow-up MR imaging performed 12 and 23 months later disclosed new extra-ganglial lesions, and review reported cases of germinoma with hemispheric atrophy.…”

Rapidly Progressing Germinoma Arising in the Lateral Ventricle and This Mimicked Choroid Plexitis

“…Ten percent of intracranial germinomas occur in offmidline locations such as the basal ganglia, thalamus or internal capsule (1,2). Ventricular development may cause migration of ectopic germ cells from the midline, which could explain the occurrence of germinomas in the off-midline structures (3).…”

Basal ganglia germinomas in children. Four clinical cases and a literature review

“…МРТ в начальной стадии заболевания может не выявлять патологии, либо опухоль выглядит как небольшие очаги, похожие на очаги демиелинизации или ишемии. Этим обуслов-лена нередко поздняя диагностика герминомы под-корковых узлов [3,9].…”