Primary midbrain germinoma relapse-free for 5 years: A case report

Abstract

Background: The biology and clinical course of intracranial germinomas differ as per their location of occurrence. Germinoma of the primary midbrain is particularly rare, and its clinical features, treatment strategies, and long-term prognosis remain uncertain. Case Description: A 39-year-old man who had been diagnosed with midbrain germinoma by open biopsy through the occipital transtentorial approach had undergone chemoradiotherapy and achieved 5 years with no recurrence. Conclusion: Germinomas should be considered as a differential diagnosis for adolescents and young adult men with mesencephalic tumors, and reliable sampling followed by chemoradiotherapy must be performed.

A case of midbrain germinoma: A literature review for radiographic and clinical features

“…High-intensity lesions on FLAIR were asymmetrically extended to the bilateral thalamus. 2 , 6 , 7 , 9 These findings are relatively distinctive for midbrain germinoma and different from those of pilocytic astrocytoma in the tectal region and diffuse midline glioma, H3 K27-altered. Pilocytic astrocytoma in the tectal region typically shows high intensity on T2-weighted images and less contrast enhancement.…”

“…Seven of the 9 cases showed lesions in the medial thalamus, along with the tegmentum of the midbrain lesions. 2 , 4 , 6–9 Moreover, 5 cases demonstrated butterfly-like radiographic features, which were shown as iso-intensity lesions on T2/FLAIR images with homogenous contrast enhancement in the midbrain. High-intensity lesions on FLAIR were asymmetrically extended to the bilateral thalamus.…”

“…Indeed, 5 midbrain germinoma cases were preoperatively suspected to be tectal glioma, diffuse intrinsic glioma, and malignant lymphoma. 2 , 5 , 6 , 8 Another 3 cases were initially treated with steroids, as nonneoplastic lesions such as sarcoidosis and multiple sclerosis were clinically suspected. 3 , 7 , 9 These 3 lesions were not biopsied until 3–4 years after initial detection.…”

“…Midbrain germinomas were biopsied and diagnosed using the following approaches ( Table 1 ): stereotactic biopsy in 5 cases, 2 , 3 , 5 , 7 , 9 open biopsy via occipital transtentorial approach in 2 cases, 4 , 6 and transventricular endoscopic biopsy in 2 cases. 8 Stereotactic biopsies can easily reach deep lesions, but small sample collection is a critical diagnostic problem.…”

“…In contrast, the endoscopic approach may be feasible in cases where the midbrain germinoma spreads to the medial side of the thalamus. Since 78% of the cases involve medial thalamic lesions, 2 , 4 , 6–9 the endoscopic approach might be reasonable for most midbrain germinomas. In addition, the endoscopic approach allows a third ventriculostomy in cases of obstructive hydrocephalus.…”