Abstract:Perioptic subarachnoid seeding may occur over a decade after presumed successful treatment of germinomas, suggesting the importance of lifelong observation.
“…The patient suffered rightsided facial numbness and pain. Moreover, Pereira et al 1 reported metastatic seeding along bilateral optic nerves in a patient 12 years after treatment of a suprasellar germinoma. There were concurrent lesions along the left trigeminal and facial (CN VII) nerves.…”
Section: Discussionmentioning
confidence: 99%
“…Albeit very rarely, leptomeningeal seeding along the optic nerve (CN II) has been reported in patients with intracranial germinoma 1 . But even then, direct leptomeningeal seeding of an IG -or of any primary CNS tumor -along the intracranial course of the trigeminal nerve, as found in our patient, has seldom been observed.…”
Intracranial germinomas (IG) are rare neoplasms. The most frequent primary sites of IG are the pineal and suprasellar regions; however, these tumors commonly disseminate to secondary sites within the central nervous system (CNS) by means of ventricular and subarachnoid cerebrospinal fluid (CSF). The incidence of bilateral Meckel's cave (MC) tumors is exceedingly low. The authors report a case of IG with metastatic involvement of bilateral MC. A review of the literature revealed that this is the first case of an intracranial germinoma -and of any primary CNS tumor -to demonstrate direct leptomeningeal seeding along both trigeminal nerves (CN V).
CASE REPORTA 15-year-old boy presented to the emergency department (ED) with a history of facial paresthesias, diplopia, headaches, and emesis. Six weeks prior, he started to develop progressive right-sided facial numbness, with weakness on chewing. Two weeks later, he began to suffer from diplopia; and shortly thereafter, he had onset of intense headaches. He arrived at the ED after a morning episode of vomiting plus headache. At presentation, he reported that his paresthesias had begun to affect the left side of his face. He did not report any hearing loss, bladder or bowel incontinence or retention, or paresthesias or paresis of any of his limbs.On examination, fundoscopy revealed no papilledema. Diplopia was worse at the lateral extremes of visual gaze. There was decreased sensation to light touch on the right side of the face in the V1 to V3 distribution. The jaw deviated to the right side in the open position, and there was weakness with lateral movement of the jaw. The rest of the neurological exam was normal.Cranial magnetic resonance imaging (MRI) revealed a nodular mass in the pineal region showing heterogeneous contrast-enhancement (Figure a). There was circumferential thickening of both trigeminal nerves, from the root entry zone (REZ) in the prepontine cistern to Meckel's caves (Figure b). Both CN V exhibited heterogeneous contrast-enhancement. Focal lesions were found in both internal acoustic canals (IAC), though the left-sided lesion was significantly larger in size (Figure c), and on the left aspect of the cervicomedullary junction (Figure d). Spinal MRI revealed several nodular lesions in the lumbar spinal cord and cauda equina (Figure i). A computed tomography (CT) scan of the chest, abdomen, and pelvis was negative for malignancy.Serum human chorionic gonadotropin (hCG) and alphafetoprotein (AFP) were within normal range: 3 mIU/mL and 1.7 ng/mL, respectively. Cerebrospinal fluid hCG and AFP were also
Intracranial Germinoma with Leptomeningeal Seeding Along Both Trigeminal NervesJetan Badhiwala, Benedicto Baronia Can J Neurol Sci. 2013; 40: 420-422 BRIEF COMMUNICATIONS within normal range: 2 mIU/mL and < 0.6 ng/mL, respectively. Cerebrospinal fluid cytology was negative for malignancy/ inflammation.An open biopsy was performed via partial laminectomy of the L1-L2 vertebrae. We decided to obtain biopsy samples from the spine, rather than the brain, du...
“…The patient suffered rightsided facial numbness and pain. Moreover, Pereira et al 1 reported metastatic seeding along bilateral optic nerves in a patient 12 years after treatment of a suprasellar germinoma. There were concurrent lesions along the left trigeminal and facial (CN VII) nerves.…”
Section: Discussionmentioning
confidence: 99%
“…Albeit very rarely, leptomeningeal seeding along the optic nerve (CN II) has been reported in patients with intracranial germinoma 1 . But even then, direct leptomeningeal seeding of an IG -or of any primary CNS tumor -along the intracranial course of the trigeminal nerve, as found in our patient, has seldom been observed.…”
Intracranial germinomas (IG) are rare neoplasms. The most frequent primary sites of IG are the pineal and suprasellar regions; however, these tumors commonly disseminate to secondary sites within the central nervous system (CNS) by means of ventricular and subarachnoid cerebrospinal fluid (CSF). The incidence of bilateral Meckel's cave (MC) tumors is exceedingly low. The authors report a case of IG with metastatic involvement of bilateral MC. A review of the literature revealed that this is the first case of an intracranial germinoma -and of any primary CNS tumor -to demonstrate direct leptomeningeal seeding along both trigeminal nerves (CN V).
CASE REPORTA 15-year-old boy presented to the emergency department (ED) with a history of facial paresthesias, diplopia, headaches, and emesis. Six weeks prior, he started to develop progressive right-sided facial numbness, with weakness on chewing. Two weeks later, he began to suffer from diplopia; and shortly thereafter, he had onset of intense headaches. He arrived at the ED after a morning episode of vomiting plus headache. At presentation, he reported that his paresthesias had begun to affect the left side of his face. He did not report any hearing loss, bladder or bowel incontinence or retention, or paresthesias or paresis of any of his limbs.On examination, fundoscopy revealed no papilledema. Diplopia was worse at the lateral extremes of visual gaze. There was decreased sensation to light touch on the right side of the face in the V1 to V3 distribution. The jaw deviated to the right side in the open position, and there was weakness with lateral movement of the jaw. The rest of the neurological exam was normal.Cranial magnetic resonance imaging (MRI) revealed a nodular mass in the pineal region showing heterogeneous contrast-enhancement (Figure a). There was circumferential thickening of both trigeminal nerves, from the root entry zone (REZ) in the prepontine cistern to Meckel's caves (Figure b). Both CN V exhibited heterogeneous contrast-enhancement. Focal lesions were found in both internal acoustic canals (IAC), though the left-sided lesion was significantly larger in size (Figure c), and on the left aspect of the cervicomedullary junction (Figure d). Spinal MRI revealed several nodular lesions in the lumbar spinal cord and cauda equina (Figure i). A computed tomography (CT) scan of the chest, abdomen, and pelvis was negative for malignancy.Serum human chorionic gonadotropin (hCG) and alphafetoprotein (AFP) were within normal range: 3 mIU/mL and 1.7 ng/mL, respectively. Cerebrospinal fluid hCG and AFP were also
Intracranial Germinoma with Leptomeningeal Seeding Along Both Trigeminal NervesJetan Badhiwala, Benedicto Baronia Can J Neurol Sci. 2013; 40: 420-422 BRIEF COMMUNICATIONS within normal range: 2 mIU/mL and < 0.6 ng/mL, respectively. Cerebrospinal fluid cytology was negative for malignancy/ inflammation.An open biopsy was performed via partial laminectomy of the L1-L2 vertebrae. We decided to obtain biopsy samples from the spine, rather than the brain, du...
“…29 This seeding may occur in a delayed manner and has been observed to occur as long as 12 years after initial diagnosis. 30 Figure 2 Midline sagittal T1 MRI with gadolinium of bifocal pineal region/suprasellar germinoma in a 15-year-old female patient. The patients had signs and symptoms of headache, bitemporal hemianopia, and polydipsia.…”
Section: Diagnosismentioning
confidence: 99%
“… 54 Because long-term outcomes remain unclear, continual follow-up is recommended even after complete remission has been achieved, 54 perhaps even for life. 30 …”
Pineal germinomas can be very complex in terms of presentation, diagnosis, and management. This review attempts to simplify this complexity in an organized manner, addressing the anatomic relationships that provide the basis for the uniqueness of pineal germinoma. Ocular findings and signs and symptoms of elevated intracranial pressure are the keys to suspecting the diagnosis and obtaining the necessary imaging and cerebrospinal fluid studies. Other symptoms can suggest spread beyond the pineal region. Surgery may only be needed to obtain tissue for a definitive diagnosis, as germinoma is highly responsive to chemotherapy and focused radiation therapy. Hydrocephalus, usually related to tumor obstruction of the cerebral aqueduct, may also need to be addressed. Outcome for pineal germinoma is usually excellent, but relapse can occur and may require additional intervention. These issues are detailed in this review.
“…Extra‐axial sites have been reported, mostly in Asian populations, in the thalamic and basal ganglia, corpus callosum, and ventricles . Initial localization in or secondary seeding dissemination to the optic nerves has seldom been reported.…”
Compression or invasion of the optic pathway by germinomas is not a rare occurrence, and this possibility should not be overlooked when thickening or contrast enhancement is detected. Radiotherapy fields should be extended accordingly.
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