Germinoma With Syncytiotrophoblastic Giant Cells Arising in the Corpus Callosum -Case Report-

Abstract

A previously healthy 31-year-old Japanese man presented with a very rare germinoma of the corpus callosum without other intracranial lesions manifesting as transitory speech disturbance. Magnetic resonance (MR) imaging revealed a heterogeneously enhanced mass in the corpus callosum extending into the cavity of the septum pellucidum. A tumor specimen obtained by stereotactic biopsy revealed a two-cell pattern germinoma containing human chorionic gonadotropin (HCG)-b-positive giant cells. The cerebrospinal fluid and serum levels of HCG and HCG-b subunit were measurable. The diagnosis was germinoma with syncytiotrophoblastic giant cells. Three cycles of chemotherapy consisting of ifosfamide, cisplatin, and etoposide, followed by radiation therapy achieved complete remission, and 5 cycles of chemotherapy with carboplatin and etoposide were added. MR imaging performed 40 months after the diagnosis showed a cicatricial cyst in the body of the corpus callosum, the original tumor site. All 11 previously reported cases of germinoma in the corpus callosum were associated with synchronous or metachronous intracranial lesions. These patients tended to be older than patients with general intracranial germinoma. Germinoma should be included in the differential diagnosis of corpus callosum tumors, especially in young adult males.

Primary cavernous sinus germinoma with atypical extension pattern: a case report and review of the literature

“…Frequently, dual intracranial germinomas are located in the pineal and suprasellar regions. Although rare, atypical locations of intracranial germinoma have also been reported 1,2,7,9,14,16,17 . Among them, one report showed trigeminal germinoma in the cavernous sinus despite a previous study stating that germinoma in the cavernous sinus always originated from the suprasellar region 1,3 .…”

“…Primary intracranial germinoma usually arises from midline structures, such as the pineal gland, suprasellar region and, subsequently, the basal ganglia. Atypical locations of intracranial germinoma have been reported in the temporal lobe 14 , corpus callosum 17 , insular lobe 9 , medulla oblongata 2,7,16 , and the trigeminal nerve 1 . One study reported that germinoma in the cavernous sinus continuously extended from the suprasellar region 3 .…”

Primary human chorionic gonadotropin secreting germinoma of the corpus callosum

“…The latter is especially in the light of a markedly raised tumor markers (b-HCG) as described in our case report. [529] Tumor marker levels in non-germinomatous germ cell tumors (NGGCT) tend to be higher, but to date, there is no definitive cut-off value that distinguishes germinoma from NGGCT, although it is commonly quoted that germinomas secrete b-HCG only up to levels of 50.0 IU/L. Cases of germinomas secreting very high levels of b-HCG have been documented,[57] complicating distinction between the former and NGGCT.…”