Germinoma with Involvement of Midline and Off-Midline Intracranial Structures

Abstract

Germinomas are malignant intracranial germ tumors, usually found in suprasellar regions. Less than 10% are localized in off-middle structures, and synchronous involvement of both structures has only exceptionally been published. A case of an 18-year-old male patient with progressive right-sided hemiparesis and panhypopituitarism was reviewed. Brain MRI showed a solid mass involving pituitary and hypothalamus with thickening of pituitary stalk, high intensity lesions on T2-weighted imaging in left internal capsule, caudate nucleus, globus pallidus, and mild atrophy of the left internal capsule and cerebral peduncle. Nonadenomatous lesions were considered in the differential diagnosis. Alfa-fetoprotein (AFP) levels were negative in both serum and cerebrospinal fluid (CSF), while β-human chorionic gonadotrophin (β-HCG) levels were slightly increased in CSF. A transsphenoidal biopsy identified a germinoma. Four cycles of chemotherapy with bleomicine, etoposide, and cysplatin were given, followed by radiotherapy, but patients died due to a recidiva. Conclusion. Germinoma must be considered in patients with insipidus diabetes with a sellar mass with thickening of pituitary stalk; and ectopic germinoma must be suspected in patients with slowly progressive hemiparesis with cerebral hemiatrophy. Even with a rare condition, colocalization of midline and off-midline germinoma must be suspected in the presence of these typical signs of both localizations.

β-human chorionic gonadotropin-secreting intracranial germ-cell tumor associated with high testosterone in an adult man: A case report

“…The majority of GCTs are located at the pineal region, followed by the suprasellar region (12). Patients with pineal germinoma may present with insomnia, but interference with pituitary function is rarely observed (13). Pineal tumors often manifest with symptoms of obstructive hydrocephalus (14) and Parinaud's syndrome, characterized by the paralysis of upward gaze and convergence, may occur in 50% of patients (15).…”

“…DI is the most common and is often the first presentation. Ophthalmic abnormalities, including bilateral hemianopsia, may also develop due to chiasmic or optic nerve compression (13). Delays in diagnosis are common and may exceed 12 months, in particular when patients present with symptoms associated with endocrinopathy, and this results in higher incidences of disseminated disease.…”

İntrakranyal Olgu Sunumlari

“…İntrakranial germinomlar en sık pineal veya suprasellar yerleşimlidir [5,6]. Bazal ganglia, talamus ve internal kapsül gibi orta hat dışı yerleşim gösteren germinomlar (ektopik olarak da tanımlanabilir) tüm intrakranial germinomların %5-10'unu oluşturur.…”

“…Çoğunlukla erkeklerde ve ilk iki dekatta görülürler [7]. Klinik prezentasyon genellikle yavaş ilerleyen hemiparezi ve/veya kognitif bozulma şeklindedir [5]. Yavaş progresyon, erken dönem nörogörüntüle-medeki hafif değişiklikler ve hatta yer kaplayan kitle yokluğu nedeniyle tanısı gecikebilir.…”

“…Yavaş progresyon, erken dönem nörogörüntüle-medeki hafif değişiklikler ve hatta yer kaplayan kitle yokluğu nedeniyle tanısı gecikebilir. Semptomların süresi ortalama 1,5 yıldır [5].…”