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Upadhyayula PS, Neira JA, Miller ML, Bruce JN. Benign and Malignant Tumors of the Pineal Region. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1405:153-173. [PMID: 37452938 DOI: 10.1007/978-3-031-23705-8_6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
Pineal region tumors fall into five broad categories: benign pineal region tumors, glial tumors, papillary tumors, pineal parenchymal tumors, and germ cell tumors. Genetic and transcriptional studies have identified key chromosomal alterations in germinomas (RUNDC3A, ASAH1, LPL) and in pineocytomas/pineoblastomas (DROSHA/DICER1, RB1). Pineal region tumors generally present with symptoms of hydrocephalus including nausea, vomiting, papilledema, and the classical Parinaud's triad of upgaze paralysis, convergence-retraction nystagmus, and light-near pupillary dissociation. Workup requires neuroimaging and tissue diagnosis via biopsy. In germinoma cases, diagnosis may be made based on serum or CSF studies for alpha-fetoprotein or beta-HCG making the preferred treatment radiosurgery, thereby preventing the need for unnecessary surgeries. Treatment generally involves three steps: CSF diversion in cases of hydrocephalus, biopsy through endoscopic or stereotactic methods, and open surgical resection. Multiple surgical approaches are possible for approach to the pineal region. The original approach to the pineal region was the interhemispheric transcallosal first described by Dandy. The most common approach is the supracerebellar infratentorial approach as it utilizes a natural anatomic corridor for access to the pineal region. The paramedian or lateral supracerebellar infratentorial approach is another improvement that uses a similar anatomic corridor but allows for preservation of midline bridging veins; this minimizes the chance for brainstem or cerebellar venous infarction. Determination of the optimal approach relies on tumor characteristics, namely location of deep venous structures to the tumor along with the lateral eccentricity of the tumor. The immediate post-operative period is important as hemorrhage or swelling can cause obstructive hydrocephalus and lead to rapid deterioration. Adjuvant therapy, whether chemotherapy or radiation, is based on tumor pathology. Improvements within pineal surgery will require improved technology for access to the pineal region along with targeted therapies that can effectively treat and prevent recurrence of malignant pineal region tumors.
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Affiliation(s)
| | - Justin A Neira
- Department of Neurological Surgery, Columbia University, New York, USA
| | - Michael L Miller
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, NY, 10032, USA
| | - Jeffrey N Bruce
- Department of Neurological Surgery, Columbia University, New York, USA.
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Cohen D, Litofsky NS. Diagnosis and Management of Pineal Germinoma: From Eye to Brain. Eye Brain 2023; 15:45-61. [PMID: 37077304 PMCID: PMC10108908 DOI: 10.2147/eb.s389631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 04/03/2023] [Indexed: 04/21/2023] Open
Abstract
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.
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Affiliation(s)
- David Cohen
- Department of Neurology, University of Missouri School of Medicine, Columbia, MO, USA
| | - N Scott Litofsky
- Department of Neurosurgery, University of Missouri School of Medicine, Columbia, MO, USA
- Correspondence: N Scott Litofsky, Department of Neurosurgery, One Hospital Drive, MC, 321, Columbia, MO, 65212, USA, Tel +1-573-882-4908, Fax +1-573-884-5184, Email
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Albiña P, Solis A, Lorenzoni J, Henny P, Manriquez M. Primary germinoma of the medulla oblongata: illustrative case. JOURNAL OF NEUROSURGERY: CASE LESSONS 2022; 3:CASE21315. [PMID: 35733824 PMCID: PMC9204933 DOI: 10.3171/case21315] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 04/11/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Primary central nervous system germinomas of the medulla oblongata are extremely rare and usually have been found in young female Asian patients. The authors present an illustrative case of a patient who presented with severe medullary and posterior cord syndrome, the first South American case published to date, to the authors’ knowledge. OBSERVATIONS Initially, the radiological differential diagnosis did not include this entity. The lesion was located at the obex and exhibited a well-delineated contrast enhancement without hydrocephalus. An emergency decompressive partial resection following functional limits was performed. After histological confirmation, radiotherapy was indicated, with complete remission achieved at a 6-month follow-up. The patient, however, continued to have a severe proprioceptive disorder. The literature review identified 21 other such patients. The mean age for this location was 23 years, with a strong female and Asian origin predilection. All tumors exhibited contrast enhancement, and only one presented with hydrocephalus. LESSONS In the absence of elevated tumor markers, radiological clues such as a well-delineated, contrast-enhanced lesion arising from the obex, without hydrocephalus, associated with demographic features such as young age, female sex, and Asian heritage, should evoke a high level of suspicion for this diagnosis. Gross total resection must not be attempted, because this tumor is potentially curable with high-dose radiotherapy.
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Affiliation(s)
- Pablo Albiña
- Neuroanatomy Lab, Department of Anatomy, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- Department of Neurosurgery, Hospital Barros Luco Trudeau, Santiago, Chile
| | - Aracelly Solis
- Intensive Care Unit, National Institute of Neurosurgery Dr. Asenjo, Santiago, Chile
| | - Jose Lorenzoni
- Department of Neurosurgery, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Pablo Henny
- Neuroanatomy Lab, Department of Anatomy, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- Interdisciplinary Center for Neuroscience, NeuroUC, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile; and
| | - María Manriquez
- Department of Pathology, Military Hospital of Santiago, Santiago, Chile
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Abstract
BACKGROUND To describe the various neuro-ophthalmic presentations, key exam features, and clinical findings associated with 5 common primary and secondary intracranial malignancies. EVIDENCE ACQUISITION Retrospective PubMed search and review of published case reports, case series, observational studies, book chapters, and review articles examining the neuro-ophthalmic features of intracranial malignancies including primary glial neoplasms (e.g., glioblastoma multiforme), primary and secondary lymphoma, intracranial metastases, carcinomatous/lymphomatous meningitis, and intracranial germ cell tumors. The search strategy used to perform the retrospective review included the aforementioned tumor type (e.g., glioblastoma multiforme) and the following terms and Boolean operators: AND ("visual loss" OR "papilledema" OR "diplopia" OR "ophthalmoplegia" or "neuro-ophthalmology" OR "proptosis"). RESULTS The rate of growth and the location of an intracranial tumor are essential factors in determining the neuro-ophthalmic presentation of certain intracranial malignancies. Primary malignant brain glial neoplasms commonly present with visual afferent complaints (e.g., unilateral or bilateral visual acuity or visual field defects, bitemporal or homonymous hemianopsia), pupil abnormalities (relative afferent pupillary defect), and optic atrophy or papilledema. Primary intraocular lymphoma (with or without central nervous system lymphoma) typically presents as a painless bilateral vitritis. Secondary intracranial malignancies have variable afferent and efferent visual pathway presentations. Carcinomatous/lymphomatous meningitis is associated with diplopia (e.g., multiple ocular motor cranial neuropathies with or without vision loss from papilledema or compressive/infiltrative optic neuropathy). Intracranial germ cell tumors can present with a chiasmal syndrome or dorsal midbrain syndrome. CONCLUSION Intracranial malignancies can present with neuro-ophthalmic symptoms or signs depending on topographical localization. Specific neuro-ophthalmic presentations are associated with different malignant intracranial tumors. Clinicians should be aware of the common malignant intracranial tumors and their associated clinical presentations in neuro-ophthalmology.
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Cheo H, Kim SK, Lee KH, Baek HJ, Kim YO. Mirror Movements in a Pediatric Patient with a Basal Ganglia Germinoma. ANNALS OF CHILD NEUROLOGY 2021. [DOI: 10.26815/acn.2020.00269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Pal R, Rai A, Vaiphei K, Gangadhar P, Gupta P, Mukherjee KK, Singh P, Ray N, Bhansali A, Dutta P. Intracranial Germinoma Masquerading as Secondary Granulomatous Hypophysitis: A Case Report and Review of Literature. Neuroendocrinology 2020; 110:422-429. [PMID: 31269501 DOI: 10.1159/000501886] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 07/02/2019] [Indexed: 12/22/2022]
Abstract
Germinomas are highly immunogenic tumors eliciting a strong peri-tumoral immune response that can spillover into the surrounding healthy tissues. This phenomenon can also occur in intracranial germinomas, manifesting as secondary hypophysitis. Herein, we report a case of 12-year-old-girl presenting with polyuria and polydispsia. She had central diabetes insipidus (CDI) and panhypopituitarism. Imaging revealed a sellar-suprasellar mass with infundibular stalk thickening. Transphenoidal biopsy revealed epithelioid granulomas with immunostaining negative for germinomatous cells. Other causes of hypophysitis were ruled out. Accordingly, she was diagnosed as primary granulomatous hypophysitis and treated with high-dose corticosteroids. Three years later she again presented with headache, vomiting and diminution of vision. Imaging showed a heterogeneous, solid-cystic peripheral rim-enhancing lesion at the same location with involvement of hypothalamus, ependyma and pineal gland. Cerebrospinal fluid beta-human chorionic gonadotropin was markedly elevated, confirming the diagnosis of an intracranial germ cell tumor. She was started on chemotherapy; however, she succumbed to febrile neutropenia. We performed a literature search and found 18 anecdotal cases of secondary hypophysitis associated with intracranial germinomas. There was a slight male preponderance (male:female 5:4). Two-thirds of the cases were below 18 years of age. Polyuria was the most common presenting manifestation (83%). CDI and panhypopituitarism were seen in 89 and 78% cases, respectively. Imaging evidence of pituitary stalk thickening was seen in 12 cases (67%), while pituitary enlargement and/or sellar mass were reported in 11 cases (61%). Pineal involvement was extremely rare, being reported in only 1 case, implying the predilection of suprasellar (rather than pineal) germinomas in causing secondary hypophysitis. Histologically, 82% had lymphocytic hypophysitis, while 18% had granulomatous hypophysitis. Initially, the diagnosis of germinoma was missed in 60% of the cases who were wrongly treated with corticosteroids. To conclude, physicians should make it a dictum that all children and adolescents presenting with CDI and pituitary stalk thickening should be rigorously screened for an underlying intracranial germinoma before labeling them as primary hypophysitis.
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Affiliation(s)
- Rimesh Pal
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashutosh Rai
- Department of Neurosurgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Kim Vaiphei
- Department of Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Prakamya Gupta
- Department of Neurosurgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Kanchan Kumar Mukherjee
- Department of Neurosurgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Paramjeet Singh
- Department of Radiodiagnosis, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Nirmalya Ray
- Department of Radiodiagnosis, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Anil Bhansali
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Pinaki Dutta
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research, Chandigarh, India,
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Cossu G, Brouland JP, La Rosa S, Camponovo C, Viaroli E, Daniel RT, Messerer M. Comprehensive Evaluation of Rare Pituitary Lesions: A Single Tertiary Care Pituitary Center Experience and Review of the Literature. Endocr Pathol 2019; 30:219-236. [PMID: 31209729 DOI: 10.1007/s12022-019-09581-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The 2017 World Health Organization classification of central nervous system and endocrine tumors have introduced significant changes in the diagnostic criteria for pituitary lesions. The aim of our paper is to describe the epidemiological, clinico-pathological, and radiological features of a single consecutive institutional surgical series of rare pituitary lesions, using these new criteria. Of the 316 endoscopic endonasal trans-sphenoidal approaches performed for pituitary lesions between 2010 and 2018, 15 rare lesions were encountered. These included metastases, pituitary carcinomas, pituicytomas, granular cell tumor, primary pituitary lymphomas, germinoma, mixed gangliocytoma-adenoma, hypophysitis, and pituitary hyperplasia. Their clinical, radiological, and pathological features are herewith presented along with a literature review that enabled us to propose an algorithm to facilitate a diagnosis for rare pituitary lesions.
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Affiliation(s)
- Giulia Cossu
- Department of Neurosurgery, Lausanne University Hospital, Rue du Bugnon 44, 1005, Lausanne, Switzerland
| | - Jean-Philippe Brouland
- Department of Clinical Pathology, Institute of Pathology, Lausanne University Hospital, Lausanne, Switzerland
- University of Lausanne, Lausanne, Switzerland
| | - Stefano La Rosa
- Department of Clinical Pathology, Institute of Pathology, Lausanne University Hospital, Lausanne, Switzerland
- University of Lausanne, Lausanne, Switzerland
| | - Chiara Camponovo
- Department of Endocrinology, University Hospital of Lausanne, Lausanne, Switzerland
| | - Edoardo Viaroli
- Department of Neurosurgery, Lausanne University Hospital, Rue du Bugnon 44, 1005, Lausanne, Switzerland
| | - Roy Thomas Daniel
- Department of Neurosurgery, Lausanne University Hospital, Rue du Bugnon 44, 1005, Lausanne, Switzerland
- University of Lausanne, Lausanne, Switzerland
| | - Mahmoud Messerer
- Department of Neurosurgery, Lausanne University Hospital, Rue du Bugnon 44, 1005, Lausanne, Switzerland.
- University of Lausanne, Lausanne, Switzerland.
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Takada A, Ii N, Hirayama M, Toyoda H, Matsubara T, Toyomasu Y, Kawamura T, Daimon T, Sakuma H, Nomoto Y. Long-term follow-up of intensive chemotherapy followed by reduced-dose and reduced-field irradiation for intracranial germ cell tumor. J Neurosurg Pediatr 2019; 23:317-324. [PMID: 30497152 DOI: 10.3171/2018.9.peds18181] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 09/06/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The authors analyzed the efficacy of intensive chemotherapy followed by reduced-dose and reduced-field irradiation for intracranial germ cell tumors (GCTs) and evaluated the long-term late effects caused by chemoradiotherapy (CRT). METHODS The authors performed a retrospective study. The subjects were 24 patients who received CRT between April 1994 and April 2015. After surgery, intensive chemotherapy followed by reduced-dose and reduced-field irradiation was administered. For those with pure germinoma, who comprised the “good prognosis” group, five courses of conventional-dose chemotherapy (CDC) were administered, and radiotherapy (24 Gy) was applied to the whole ventricle. For all others, defined as the “intermediate and poor prognosis” group, two or three courses of CDC and high-dose chemotherapy were administered with peripheral blood stem cell transplantation and radiotherapy (24–30 Gy) applied to the whole ventricle or a larger field with or without local boost irradiation (20 Gy), which was applied as needed. RESULTS The median period of follow-up was 112.5 months (range 28–261 months), and the 5-/10-year overall and progression-free survival rates were 100%/83.5% and 91.3%/86.5%, respectively. The 5-/10-year overall survival rates determined based on the histological subtypes were 100%/100% for pure germinoma and 93.8%/78.7% for others, respectively. The late toxicities were as follows: endocrine disorder (33% in pure germinoma, 56% in others), involuntary movements (17% in pure germinoma, 39% in others), ear and labyrinth disorders (17% in pure germinoma, 33% in others), and psychiatric disorders (0% in pure germinoma, 33% in others). Nineteen of 24 patients underwent MRI (T2*- or susceptibility-weighted imaging) after radiotherapy, and 16 (84%) of those 19 patients had microbleeds detected, while 2 (10.5%) had radiation-induced cavernous vascular malformations detected. CONCLUSIONS Intensive chemotherapy followed by reduced-dose and reduced-field irradiation for intracranial GCTs had the same outcome as that reported in the literature, but late adverse effects after treatment were observed. Almost all of the complications were relatively mild but had the potential to lead to psychiatric disorders and intracranial hemorrhaging. ABBREVIATIONS AFP = alpha-fetoprotein; CDC = conventional-dose chemotherapy; CMB = cerebral microbleed; CRT = chemoradiotherapy; CSI = craniospinal irradiation; EP = etoposide and cisplatin; GCT = germ cell tumor; HCG = human chorionic gonadotropin; HDC = high-dose chemotherapy; ICE = ifosfamide, cisplatin, and etoposide; NGGCT = nongerminomatous GCT; OS = overall survival; PBSCT = peripheral blood stem cell transplantation; PFS = progression-free survival; RICM = radiation-induced cavernous malformation; STGC = syncytiotrophoblastic giant cell; SWI = susceptibility-weighted imaging.
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Affiliation(s)
| | - Noriko Ii
- Department of Radiation Oncology, Ise Red Cross Hospital, Ise City, Mie
| | | | | | | | | | | | - Takashi Daimon
- Department of Biostatistics, Hyogo College of Medicine, Nishinomiya City, Hyogo; and
| | | | - Yoshihito Nomoto
- Radiation Oncology, Mie University Graduate School of Medicine, Tsu City, Mie, Japan
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Chen YT, Su KP, Chang JPC. Atypical major depressive episode as initial presentation of intracranial germinoma in a male adolescent. Neuropsychiatr Dis Treat 2017; 13:35-40. [PMID: 28053535 PMCID: PMC5191621 DOI: 10.2147/ndt.s118902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
A 17-year-old adolescent boy presented with atypical major depressive episode (MDE) without specific focal neurological signs for 6 months. He had a diagnosis of intra-cranial germinoma, and the atypical MDE symptoms subsided after the operation. However, he had a relapse of atypical MDE 7 months after the first surgery. His mood and binge eating symptoms subsided, but intractable body weight gain only partially improved after treatment. When encountering manifestations of depression with atypical features, especially with binge eating symptoms in male children and adolescents, with early onset age, no family history, and prolonged depressive episodes, clinicians should consider not only mood disorders including bipolar spectrum disorders but also organic brain lesions such as intracranial germinoma.
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Affiliation(s)
- Yi-Ting Chen
- Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan; School of Medicine, China Medical University, Taichung, Taiwan; Department of Psychiatry, China Medical University Hospital, Taichung, Taiwan
| | - Kuan-Pin Su
- Graduate Institute of Neural and Cognitive Sciences, China Medical University, Taichung, Taiwan; School of Medicine, China Medical University, Taichung, Taiwan; Department of Psychiatry, China Medical University Hospital, Taichung, Taiwan; Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Jane Pei-Chen Chang
- Graduate Institute of Neural and Cognitive Sciences, China Medical University, Taichung, Taiwan; School of Medicine, China Medical University, Taichung, Taiwan; Department of Psychiatry, China Medical University Hospital, Taichung, Taiwan; Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Hu Q, Yu W, Du Q, Zhu Q, Che Z. Primary extramedullary spinal germinoma: case report and review of the literature. Neurosurg Rev 2016; 40:171-176. [PMID: 27822593 DOI: 10.1007/s10143-016-0793-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 09/26/2016] [Accepted: 09/30/2016] [Indexed: 11/25/2022]
Abstract
The authors describe a case of a purely primary extramedullary spinal germinoma in a young Chinese male. Primary spinal germinoma is extremely rare tumor. Currently, less than 30 histologically verified spinal germinoma cases have been reported previously, mostly involving Asian of Japanese descent. This 24-year-old male suffered from progressive low back pain radiating to both legs. Magnetic resonance imaging showed a well-demarcated, intradural extramedullary mass at the level of L2 and L3. The lesion was totally removed and was confirmed as a germinoma. Upon histological verification of the tumor, he was treated successfully with radiotherapy and adjuvant chemotherapy. This report also reviews the literature pertaining to primary spinal germinoma. Except for 16 cases with intramedullary lesions and five cases with both intra- and extramedullary tumors, there were only three previously reported cases of extramedullary spinal germinomas, all initially presenting with sausage-like lesions. To the authors' knowledge, it is thought to be the first case of such a tumor, roughly round in shape and extramedullary location. Although rare, primary spinal germinoma do occur and should be included in the differential diagnosis of spinal tumors. Aggressive malignant behavior has been reported and close follow-up is necessary.
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Affiliation(s)
- Qiang Hu
- Department of Neurosurgery, Hangzhou First People's Hospital, Nanjing Medical University, Hangzhou, People's Republic of China
| | - Wenhua Yu
- Department of Neurosurgery, Hangzhou First People's Hospital, Nanjing Medical University, Hangzhou, People's Republic of China.
| | - Quan Du
- Department of Neurosurgery, Hangzhou First People's Hospital, Nanjing Medical University, Hangzhou, People's Republic of China
| | - Qiang Zhu
- Department of Neurosurgery, Hangzhou First People's Hospital, Nanjing Medical University, Hangzhou, People's Republic of China
| | - Zhihao Che
- Department of Neurosurgery, Hangzhou First People's Hospital, Nanjing Medical University, Hangzhou, People's Republic of China
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Congenital Mature Intracranial Teratoma in a Pampas Deer (Ozotoceros bezoarticus) in Brazil. J Wildl Dis 2016; 52:749-52. [PMID: 27310166 DOI: 10.7589/2015-03-070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
A 19-year-old Caucasian male presented with complaints of headaches and syncope. Suspicion of hydrocephalus prompted computed tomography (CT) and magnetic resonance imaging (MRI), which revealed pineal and suprasellar prominences with diffuse, thick, nodular subependymal enhancement of the lateral and third ventricles. Based on imaging, the differential diagnosis consisted primarily of malignancy, such as lymphoma, with inflammatory and infectious etiologies not excluded. Cerebrospinal fluid (CSF) samples were non-specific, and neuroendoscopic tissue biopsy histologically confirmed the diagnosis of pure germinoma. The patient was treated with radiation, and follow-up MRIs at one, three, six, and 12 months demonstrated progressive resolution of tumor burden with marked clinical improvement. Germinomas are rare germ cell tumors that are more frequently diagnosed in Asian countries. They uncommonly seed into the lateral ventricles, and only two other cases have been described with diffuse subependymal involvement. Unlike other malignant germ cell tumors, germinomas have marker negative CSF samples that are important in the normal diagnostic workup of diffuse subependymal lesions. Histopathologic correlation is required for definitive diagnosis in the United States and can be achieved with endoscopic tissue sampling. Germinomas are highly radio- and chemotherapy sensitive and have a fair prognosis with modern therapeutic techniques. Germinoma should be considered with simultaneous midline and diffuse ventricular lesions.
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Affiliation(s)
| | | | - Julian J Lin
- Neurosurgery, University of Illinois College of Medicine at Peoria
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Sonabend AM, Bowden S, Bruce JN. Microsurgical resection of pineal region tumors. J Neurooncol 2016; 130:351-366. [PMID: 27193692 DOI: 10.1007/s11060-016-2138-5] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 05/02/2016] [Indexed: 11/26/2022]
Abstract
The extensive variety of possible histologic subtypes makes it imperative to establish a tissue diagnosis in patients with pineal region tumors. Management decisions regarding adjuvant therapy, prognosis, and follow-up strategies vary with the histologic diagnosis. Specialized surgical and stereotactic techniques have evolved to provide the neurosurgeon with an array of safe and effective options for obtaining a tissue diagnosis. Advanced microsurgical techniques combined with improved preoperative management and postoperative critical care methods have made aggressive surgical resection a mainstay of management. Aggressive surgical resection has resulted in excellent long-term prognoses for nearly all patients with benign tumors and a large percentage of patients with malignant tumors. However, pineal region surgery remains fraught with potential pitfalls, and these favorable results are dependent on an advanced level of surgical expertise.
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Affiliation(s)
- Adam M Sonabend
- Department of Neurological Surgery, Columbia University Medical Center, New York, NY, USA
| | - Stephen Bowden
- Department of Neurological Surgery, Columbia University Medical Center, New York, NY, USA
| | - Jeffrey N Bruce
- Department of Neurological Surgery, Columbia University Medical Center, New York, NY, USA.
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Abstract
The following is a general overview of the management of CNS germinomas. Over the last 35 years, CNS germinomas have become one of the pediatric brain tumors with the best outcomes with a greater than 85% overall survival over 5 years. This is in part due to the fact that germinomas are very responsive to chemotherapy and radiation. Some of the major challenges going forward will be to find ways to minimize the adverse effects of our treatments particularly with regard to radiation and to improve the quality of life of patients who develop neurologic, neurocognitive and/or endocrine deficiencies.
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Affiliation(s)
- Diana S Osorio
- Langone Medical Center, New York University, New York, NY, USA.,Nationwide Children's Hospital, Columbus, OH, USA
| | - Jeffrey C Allen
- Langone Medical Center, New York University, New York, NY, USA
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Wu L, Yang T, Deng X, Yang C, Fang J, Xu Y. Treatment strategies and long-term outcomes for primary intramedullary spinal germinomas: an institutional experience. J Neurooncol 2014; 121:541-8. [PMID: 25381638 DOI: 10.1007/s11060-014-1662-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 11/06/2014] [Indexed: 12/28/2022]
Abstract
Primary intramedullary germinomas are very rare tumors in the spinal cord. This study presented a series of 11 patients with histologically proven primary intramedullary spinal germinomas. Their clinical and radiological findings, treatment records and long-term outcomes were reviewed. There were four male and seven female patients with a mean age of 27.1 years. Because germ cell tumors were suspected by frozen-section biopsy, gross total resection was unattempted. Partial resection was performed in four cases, while biopsy was performed in seven cases. Postoperatively, carboplatin and etoposide chemotherapy combined with low dose radiotherapy (30.6 Gy) to local spine was performed in seven cases, followed by radiotherapy alone (40 Gy) in four cases. All 11 patients had a complete response to either combination treatment or single radiotherapy, and the mass effect on the spinal cord vanished. The mean follow-up period was 75.4 months. At the last follow-up, the symptoms were improved in 10 cases and the current status of one patient was unchanged. The postoperative follow-up magnetic resonance imaging showed no recurrence or dissemination in any of the patients. Primary intramedullary germinomas are amenable to adjuvant radiochemotherapy and low dose radiation with etoposide and carboplatin chemotherapy is recommended. When combination therapy cannot be performed, relatively high doses of radiotherapy are advised, and radiation to the craniospinal axis may be unnecessary. A good clinical outcome after combination therapy or radiotherapy alone can be expected, and the risk of long-term recurrence and dissemination is low.
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Affiliation(s)
- Liang Wu
- Department of Neurosurgery, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, No.6 Tiantan Xili, Dongcheng District, Beijing, 100050, China
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Kakigi T, Okada T, Kanagaki M, Yamamoto A, Fushimi Y, Sakamoto R, Arakawa Y, Mikami Y, Shimono T, Takahashi JC, Togashi K. Quantitative imaging values of CT, MR, and FDG-PET to differentiate pineal parenchymal tumors and germinomas: are they useful? Neuroradiology 2014; 56:297-303. [PMID: 24510202 DOI: 10.1007/s00234-014-1334-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Accepted: 01/22/2014] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Quantitative values of CT attenuation, apparent diffusion coefficient (ADC), and standardized uptake value (SUV) were investigated for differentiation between pineal parenchymal tumors (PPTs) and germinomas. Differences in age, sex, and calcification pattern were also evaluated. METHODS Twenty-three patients with PPTs and germinomas in 20 years were retrospectively enrolled under the approval of the institutional review board. CT attenuation, ADC, and SUV (20, 13, and 10 patients, respectively) were statistically compared between the two tumors. Differences in sex and patterns of calcification ("exploded" or "engulfed") were also examined. Mean patient ages were compared among three groups of pineoblastoma, pineal parenchymal tumor of intermediate differentiation, (PPTID) and pineocytoma and germinoma. RESULTS None of the quantitative values of CT attenuation, ADC, and SUV showed significant differences between PPTs and germinomas (p > .05). However, there was a significant difference in age (p < .05) among the three groups of pineoblastoma (mean age ± standard deviation 7.0 ± 8.7 years), PPTID, and pineocytoma (53.7 ± 11.4 years) and germinoma (19.1 ± 8.1 years). Sex also showed significant differences between PPTs and germinomas (p = .039). Exploded pattern of calcification was found in 9 of 11 PPT patients and engulfed pattern in 7 of 9 patients with germinomas. No reverse pattern was observed, and the patterns of calcification were considered highly specific of tumor types. CONCLUSIONS None of the quantitative imaging values could differentiate PPTs from germinomas. Age, sex, and calcification patterns were confirmed useful in differentiating these tumors to some degree.
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Affiliation(s)
- Takahide Kakigi
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
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Rousselle C, des Portes V, Berlier P, Mottolese C. Pineal region tumors: Clinical symptoms and syndromes. Neurochirurgie 2014; 61:106-12. [PMID: 24439798 DOI: 10.1016/j.neuchi.2013.08.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Accepted: 08/04/2013] [Indexed: 10/25/2022]
Abstract
The present paper investigates the clinical picture and the different clinical signs that reveal pineal region tumors or appear during the course of the follow-up. Biological malignancy and tumor extension determine the semiology and its setting up mode. Typical endocrine signs, dominated by abnormal puberty development, are frequently a part of the clinical scene. Bifocal or ectopic localization in the hypothalamic-pituitary region is accompanied by other endocrine signs such as ante- or post-pituitary insufficiencies which occur several months or even years after the first neurological signs appear. Due to a mass syndrome and obstructive hydrocephalus, intracranial hypertension signs are frequent but unspecific. A careful ophthalmologic examination is essential to search upward gaze paralysis and other signs of the Parinaud's tetrad or pentad. Midbrain dysfunction, including extrinsic aqueduct stenosis, are also prevalent. Except for abnormal pubertal signs, hyper-melatoninemia (secretory tumors) or a-hypo-melatoninemia (tumors destructing pineal) generally remains dormant. Some patients present sleep problems such as narcolepsy or sleepiness during the daytime as well as behavioral problems. This suggests a hypothalamic extension rather than a true consequence of melatonin secretion anomalies. Similarly, some patients may present signs of a "pinealectomized" syndrome, including (cluster) headaches, tiredness, eventually responsive to melatonin.
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Affiliation(s)
- C Rousselle
- Service de neurochirurgie pédiatrique, hôpital neurologique, groupe hospitalier Est, 59, boulevard Pinel, 69500 Bron, France; Service de neuropédiatrie, hôpital femme-mère-enfant, groupe hospitalier Est, 59, boulevard Pinel, 69500 Bron, France.
| | - V des Portes
- Service de neuropédiatrie, hôpital femme-mère-enfant, groupe hospitalier Est, 59, boulevard Pinel, 69500 Bron, France
| | - P Berlier
- Service de neurochirurgie pédiatrique, hôpital neurologique, groupe hospitalier Est, 59, boulevard Pinel, 69500 Bron, France; Service d'endocrinologie pédiatrique, hôpital femme-mère-enfant, groupe hospitalier Est, 59, boulevard Pinel, 69500 Bron, France
| | - C Mottolese
- Service de neurochirurgie pédiatrique, hôpital neurologique, groupe hospitalier Est, 59, boulevard Pinel, 69500 Bron, France
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Chuan Aaron FS, Dawn CQQ, Kenneth CTE, Hoe NW, Yen SS, Chee Kian T. Primary human chorionic gonadotropin secreting germinoma of the corpus callosum. Surg Neurol Int 2013; 4:137. [PMID: 24233184 PMCID: PMC3815051 DOI: 10.4103/2152-7806.119537] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Accepted: 08/23/2013] [Indexed: 12/14/2022] Open
Abstract
Background: Primary intracranial germinomas are a rare subset of intracranial tumors derived from mis-incorporated germ cells within the folding neural plate during embryogenesis. Though known to arise from midline structures in the central nervous system (CNS), occurrence within the corpus callosum is exceedingly rare. Case Description: We present a rare case of secreting primary intracranial germinoma with extensive intraventricular metastasis presenting as a multi-cystic butterfly lesion in the genu of the corpus callosum in a young boy. Conclusion: Intracranial germ cell tumors must be considered for any multi-cystic lesion arising from midline structures in the CNS in the preadult population.
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Affiliation(s)
- Foo Song Chuan Aaron
- Department of Medical Oncology, National Cancer Centre, 11 Hospital Drive, Singapore 169610
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20
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Ober CA, Taulescu M, Oana L, Bel L, Cătoi C, Fărcas L, Pestean C. An unusual case of a mature teratoma on the left perineal region of a young cat: surgical treatment and pathological description. Acta Vet Scand 2013; 55:51. [PMID: 23844766 PMCID: PMC3720244 DOI: 10.1186/1751-0147-55-51] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Accepted: 07/04/2013] [Indexed: 11/10/2022] Open
Abstract
A 10-month-old intact male cat with a clinical history of a large mass in the left perineal region was submitted to the surgery department. The mass had reportedly been present as a small swelling after birth. Cytological evaluation using a fine-needle aspirate showed eosinophilic keratinaceous debris, and was not convincing for the definitive diagnosis. Complete surgical excision was performed. Postoperative function and aesthetics were excellent. Based on gross and histological features the definitive diagnosis of the tumor was mature teratoma with ectodermal and endodermal components. After a follow-up period of 4 months, no signs of recurrence were evident. Surgical excision of the teratoma in our case was considered curative. A perineal location has not been previously reported in the cat and should be considered a rare condition in this species.
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21
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Fang AS, Meyers SP. Magnetic resonance imaging of pineal region tumours. Insights Imaging 2013; 4:369-82. [PMID: 23640020 PMCID: PMC3675249 DOI: 10.1007/s13244-013-0248-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Revised: 03/19/2013] [Accepted: 03/28/2013] [Indexed: 12/23/2022] Open
Abstract
Objectives Pineal lesions can present as a heterogeneous collection of benign and malignant disease conditions. Pineal lesions include germ cell tumours, neoplasms arising from the pineal parenchyma, as well as other pineal region masses. Methods A variety of cases of pineal lesions are presented. The important clinical features and typical imaging findings of each pineal lesion are described with emphasis on their morphological appearance and signal intensity characteristics on magnetic resonance imaging (MRI). Conclusion Knowledge of the imaging characteristics and clinical features of varying pineal lesions can assist in narrowing the differential diagnosis for more accurate and rational therapeutic planning. Teaching Points • Pineal parenchymal tumours show an “explosion” of normal pineal calcifications towards the periphery. • Pineoblastomas often have restricted diffusion, with apparent diffusion coefficient (ADC) values lower than germinomas. • Pineal teratomas and pineal lipomas display fat signal characteristics and fat saturation on MRI. • Pineal lesions in patients with known malignancy should raise suspicion of metastatic involvement. • Pineal cysts and arachnoid cysts show MRI signal characteristics similar to cerebrospinal fluid (CSF).
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Affiliation(s)
- Adam S Fang
- Department of Imaging Sciences, University of Rochester Medical Center School of Medicine and Dentistry, 601 Elmwood Ave, Box 648, Rochester, NY, 14642, USA,
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22
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Mehta VA, Kretzer RM, Orr B, Jallo GI. Primary intramedullary spinal germ cell tumors. World Neurosurg 2011; 76:478.e1-6. [PMID: 22152582 DOI: 10.1016/j.wneu.2011.01.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2010] [Accepted: 01/14/2011] [Indexed: 12/16/2022]
Abstract
BACKGROUND Intramedullary spinal germ cell tumors are rare lesions, with germinomas being the most common variant. METHODS To date, there have been 23 reports of primary intramedullary germ cell tumors described in the literature, the vast majority occurring in Japanese patients. RESULTS We present a case of a nonmetastatic intramedullary germ cell tumor in a 28-year-old Caucasian woman. CONCLUSIONS Characteristics of intramedullary germ cell tumors are summarized, and the current role for surgery and adjuvant radiation and chemotherapy are discussed.
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Affiliation(s)
- Vivek A Mehta
- Department of Neurosurgery, The Johns Hopkins Hospital, Baltimore, Maryland, USA
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23
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Wildemberg LEA, Vieira Neto L, Taboada GF, Moraes AB, Marcondes J, Conceição FL, Chimelli L, Gadelha MR. Sellar and suprasellar mixed germ cell tumor mimicking a pituitary adenoma. Pituitary 2011; 14:345-50. [PMID: 19116786 DOI: 10.1007/s11102-008-0161-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Germ cell tumors (GCT) are a heterogeneous group of lesions whose origin is not well established. Several cases of primary intrasellar germinomas have been reported, however non-germinomatous GCT have rarely been described. We report the case of a young adult male patient with a mixed GCT that presented with a sellar tumor with suprasellar extension. The patient seeked medical attention because of seizures and magnetic resonance imaging evidenced a tumor of the sellar region. Hyperprolactinemia was also present and dopamine agonist therapy was started. As there was a rapid tumor growth and the patient had concomitant central diabetes insipidus and elevated testosterone levels, a GCT was suspected and confirmed by elevated serum concentration of β-human chorionic gonadotrophin. Patient underwent surgical resection of the tumor and histopathological examination confirmed the diagnosis of a mixed GCT. Chemotherapy was initiated, followed by conventional radiotherapy. In conclusion, although pituitary adenomas respond for the vast majority of sellar tumors, concomitant symptoms such as central diabetes insipidus and rapid tumor growth should raise the suspicion of a diverse diagnosis. The present report intend not only to show a rare case of sellar and suprasellar mixed GCT but also to remind clinicians that if laboratory findings do not fit into patient's diagnosis (such as high testosterone levels in our patient), then the diagnosis should be reviewed.
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Affiliation(s)
- Luiz Eduardo Armondi Wildemberg
- Endocrinology Unit, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil.
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Terasaka S, Kawabori M, Kobayashi H, Murata J, Kanno H, Tanaka S, Houkin K. Neurohypophyseal germinoma with abundant fibrous tissue. Brain Tumor Pathol 2011; 29:58-62. [PMID: 21918862 DOI: 10.1007/s10014-011-0063-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2011] [Accepted: 08/13/2011] [Indexed: 12/14/2022]
Abstract
We report an unusual case of neurohypophyseal germinoma with abundant fibrous tissue and clival invasion that was initially misdiagnosed as lymphocytic hypophysitis. A 40-year-old woman presented with diabetes insipidus and panhypopituitarism after delivering her second son and which lasted for 4 years. Magnetic resonance imaging showed the intrasellar mass extending to the suprasellar region with enlarged pituitary stalk. The mass was heterogeneously enhanced and invaded the clivus. Biopsy of the intrasellar mass was performed via the trans-sphenoidal route, and histological examination revealed marked fibrous tissue and infiltration of lymphocytes, with no evidence of tumor cells. Lymphocytic hypophysitis was the initial diagnosis, and corticosteroid therapy was begun. Despite intensive treatment, the lesion enlarged and clinical symptoms worsened 2 weeks after surgery. Subtotal removal of the mass was performed, and a second histological examination revealed typical findings of the germinoma. Subsequently, the patient underwent chemoradiotherapy, and complete remission was achieved. Histological diagnosis is sometimes incorrect in fibrous tumors at the sellar region, and biopsy from several points is strongly recommended for this entity.
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Affiliation(s)
- Shunsuke Terasaka
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, North 15 West 7, Kita-ku, Sapporo, 060-8638, Japan
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25
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Kim JP, Park BJ, Lim YJ. A primary intrasellar mixed germ cell tumor with suprasellar extension. Childs Nerv Syst 2011; 27:1161-4. [PMID: 21494887 DOI: 10.1007/s00381-011-1415-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2010] [Accepted: 02/22/2011] [Indexed: 10/18/2022]
Affiliation(s)
- Joo Pyung Kim
- Department of Neurosurgery, Kyung Hee University, Seoul, 130-702, Korea
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26
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Intracranial germinoma: clinical and MRI findings in 56 patients. Childs Nerv Syst 2010; 26:1773-7. [PMID: 20665036 DOI: 10.1007/s00381-010-1247-2] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2010] [Accepted: 07/20/2010] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Intracranial germinoma is a rare malignant tumor, only constituting 0.5-2.0% of all primary intracranial tumors. It usually occurs in children and young adults, it is highly sensitive to radiotherapy or/and chemotherapy, and is potentially curable without operation. To make correct pre-operative diagnosis and spare surgical intervention, we retrospectively reviewed 56 patients in our hospital, and presented clinical findings and MRI characteristics. MATERIALS AND METHODS We reviewed medical records and magnetic resonance imaging (MRI) of 56 patients. Information regarding sex, age at diagnosis, clinical presentation, duration of symptom, and associated neurologic deficits was noted. The tumor location, number of metastasis, size, margin, involved tissues, and characteristics of signal intensity on MRI were analyzed by two experienced radiologists, respectively. RESULTS In the series, 57% of intracranial germinoma was located in pineal region, 32% in suprasellar region, and 9% in basal ganglia region. One patient was found germinoma with synchronous lesions in pineal and suprasellar region. Sixty-three percent of patients were male in pineal region, 39% and 100%, respectively, in suprasellar region and basal ganglia region. Age at diagnosis ranged from 3 to 21 years (mean, 12.5 years) with a peak between 10 and 18 years. CONCLUSIONS Intracranial germinoma has some features in terms of age, sex, clinical presentation, and MRI. These features are in favor of pre-operative diagnosis and thus make for good prognosis.
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27
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Xu E, Wang X, Hao Z, Chen Z, Lu X. Germinoma in the basal ganglia with an abnormal karyotype: case report and review of the literature. Childs Nerv Syst 2010; 26:707-12. [PMID: 19876633 DOI: 10.1007/s00381-009-1007-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2009] [Revised: 09/10/2009] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Germ cell tumor of basal ganglia with abnormal constitutional karyotype has been rarely reported. CASE REPORT A 9-year-old boy presented with precocious puberty and right hemiparesis. Magnetic resonance imaging showed high intensity on T1-weighted, T2-weighted, and contrast-enhanced T1-weighted images in the left basal ganglia and ipsilateral cerebral hemiatrophy predominantly in the basal ganglia and midbrain. Germinoma in the left basal ganglia was confirmed by stereotactic biopsy and immunochemical examination. His constitutional karyotype was 46, XY, t (8; 19), (p23.1; p13.1), a novel chromosomal abnormality. DISCUSSION Intracranial germinoma, a potentially curable tumor, should be considered in children with nonspecific neurological symptoms, endocrinologic changes, and ipsilateral cerebral hemiatrophy on computed tomography or magnetic resonance. Investigation of chromosomal aberrations in those patients would clarify the tumorigenesis and lead to possibilities for novel disease-specific therapies.
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Affiliation(s)
- En Xu
- Institute of Neurosciences, The Second Affiliated Hospital of Guangzhou Medical College, 250 Changgang Dong RD, Guangzhou 510260, People's Republic of China.
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Attention deficit hyperactivity disorder: diagnosis and treatment masking the ophthalmic clinical presentation of a pineal gland tumour in a teenager. Int Ophthalmol 2010; 30:727-30. [DOI: 10.1007/s10792-010-9356-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2009] [Accepted: 02/01/2010] [Indexed: 11/25/2022]
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Suprasellar Germinoma Masquerading As Lymphocytic Hypophysitis Associated With Central Diabetes Insipidus, Delayed Sexual Development, and Subsequent Hypopituitarism. Am J Med Sci 2010; 339:195-9. [DOI: 10.1097/maj.0b013e3181c11713] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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30
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Douglas-Akinwande AC, Ying J, Momin Z, Mourad A, Hattab EM. Diffusion-weighted imaging characteristics of primary central nervous system germinoma with histopathologic correlation: a retrospective study. Acad Radiol 2009; 16:1356-65. [PMID: 19643635 DOI: 10.1016/j.acra.2009.05.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2009] [Revised: 05/28/2009] [Accepted: 05/29/2009] [Indexed: 01/12/2023]
Abstract
RATIONALE AND OBJECTIVES The aim of this study was to quantify, using diffusion-weighted magnetic resonance imaging, the microscopic rate of water diffusion in pure germinoma and to determine whether or not the apparent diffusion coefficient (ADC) values correlated with the different histologic components. MATERIALS AND METHODS A retrospective analysis of echoplanar diffusion-weighted magnetic resonance images was conducted on 10 patients with 11 germinoma lesions. All images were obtained using 1.5-T magnets with a b value of 1000 s/mm(2). Regions of interest were drawn separately within the solid and the cystic or necrotic components of each germinoma, as well as within the normal gray and white matter of the respective cases, to calculate ADCs. The diffusion characteristics of the germinomas were assessed using mean and normalized ADC values. Histologic samples from all cases were blindly reviewed and then correlated with the ADC values. RESULTS Data are expressed as mean +/- standard error. Evaluation of the solid components revealed that 36% of germinomas (4 of 11) had predominantly restricted diffusion (ADC(solid), 694.71x10(-6)+/-74.54x10(-6) s/mm(2); ADC ratio, 0.84+/-0.07) compared to normal brain. The majority (55% [6 of 11]) had normal diffusion (ADC(solid), 947.64x10(-6)+/-54.38x10(-6) s/mm(2); ADC ratio, 1.14+/-0.10). Only 9% (1 of 11) had increased diffusion (ADC(solid), 1172.30x10(-6)+/-48.52x10(-6) s/mm(2); ADC ratio, 1.67+/-0.16). The cystic and necrotic components had a mean ADC ratio of 2.55+/-0.25. There was no significant correlation between the histologic components and the ADC values of germinomas. CONCLUSIONS The vast majority of germinomas demonstrated predominantly restricted (36%) or normal (55%) diffusion. The histologic components were not correlated with the ADC values.
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Affiliation(s)
- Annette C Douglas-Akinwande
- Department of Radiology, Indiana University School of Medicine, 550 North University Boulevard, University Hospital 0279, Indianapolis, IN 46202, USA.
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Yang DT, Rozen WM, Rickert CH, Lo PA. Primary pontomedullary germinoma in a 12 year old boy. J Clin Neurosci 2009; 16:321-5. [DOI: 10.1016/j.jocn.2007.08.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2007] [Accepted: 08/21/2007] [Indexed: 10/21/2022]
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Yang KY, Li SH, Lin JW, Su TM, Ho JT, Chen WF. Concurrent chemoradiotherapy for primary cervical spinal cord germinoma. J Clin Neurosci 2008; 16:115-8. [PMID: 19008102 DOI: 10.1016/j.jocn.2007.11.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2007] [Revised: 11/09/2007] [Accepted: 11/13/2007] [Indexed: 11/25/2022]
Abstract
We report a rare case of primary intramedullary germinoma in the cervical spine of a 39-year-old woman without evidence of intracranial or disseminated disease. The germinoma was treated by a biopsy and follow-up concurrent chemoradiotherapy. This is the only reported case of primary spinal cord germinoma for which concurrent chemoradiotherapy was given. Furthermore, this is only the second reported case of histologically documented primary intramedullary cervical spinal cord germinoma. The patient was disease-free and there was near-complete resolution of the pre-operative neurological deficits at the 20-month follow-up examination.
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Affiliation(s)
- Ka-Yen Yang
- Department of Neurosurgery, Chang Gung Memorial Hospital - Kaohsiung Medical Center, Chang Gung University College of Medicine, 123 Ta-Pei Road, Niao-Sung Hsiang, Kaohsiung 833, Taiwan
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Pereira LS, Green AJ, Hwang TN, McCulley TJ. Suprasellar germinoma and late perioptic seeding. Eur J Ophthalmol 2008; 18:159-61. [PMID: 18203106 DOI: 10.1177/112067210801800130] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE To report an unusual case of optic nerve seeding 12 years following treatment of a suprasellar germinoma. METHODS Observational case report. RESULTS A 34-year-old woman presented with a 3-week history of subjective right eye visual loss. She had been diagnosed with a suprasellar germinoma at 22 years of age, which had been partially excised and radiated (5400 cGy). The tumor had shown complete radiographic regression without neurologic sequelae. Pertinent findings on current examination included right eye visual acuity of 20/150, right relative afferent papillary defect, and optic nerve pallor in the right eye. In addition, partial left facial paralysis was noted. Examination was otherwise unremarkable including 20/20 acuity in the left eye. Magnetic resonance imaging demonstrated abnormal enhancement and thickening of both optic nerves and along the course of the left V and VII cranial nerves. Serum levels of alpha-fetoprotein and beta-HCG were abnormal, consistent with metastatic germinoma. Following two cycles of chemotherapy (VIP-etoposide, ifosfamide, and cisplatin), visual acuity returned to 20/20 bilaterally, with corresponding radiographic improvement and normal cerebrospinal fluid cytology. CONCLUSIONS Perioptic subarachnoid seeding may occur over a decade after presumed successful treatment of germinomas, suggesting the importance of lifelong observation.
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Affiliation(s)
- L S Pereira
- Department of Ophthalmology, University of California, San Francisco, CA 94143, USA
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Powell M. Chapter 10 Disorders of the Sella and Parasellar Region. Neuroophthalmology 2008. [DOI: 10.1016/s1877-184x(09)70040-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Baussart B, Lepeintre JF, Condette-Auliac S, Dupuy M, Gaillard S. Localisation trigéminale d'un germinome intracrânien primitif. À propos d'un cas. Neurochirurgie 2007; 53:43-6. [PMID: 17337016 DOI: 10.1016/j.neuchi.2006.11.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2006] [Accepted: 11/24/2006] [Indexed: 12/01/2022]
Abstract
A 22-year-old man presented headache, asthenia, body weight loss and trigeminal hypoesthesia worsening quickly. Radiological analysis showed an enhanced lesion that originated from the cavernous sinus and extended into the Meckel cave, owing to the fifth cranial nerve's course. The lesion was explored by a temporo-pterional approach and was partially removed. On the basis of histological analysis and negativity of tumor marker levels in serum and cerebrospinal fluid (alpha-fetoprotein alpha, human beta-chorionic gonadotropin), a primitive non-secreting intracranial germinoma was diagnosed. Under combined chemotherapy (carboplatine, ifosfamide, etoposide) followed by focal fractionated radiotherapy delivering 40 Gy to the initial tumor volume, the outcome was excellent. Five years later, the patient was in complete clinical and radiological remission. Primitive intracranial germinomas are rare malignant tumors involving mainly pineal and hypothalamic regions. We report a case of intracranial trigeminal nerve germinoma. To the best of our knowledge, no case of primitive germinoma was previously described in this location. Aspects of diagnosis and treatment are discussed in the light of previous publishing data.
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Affiliation(s)
- B Baussart
- Service de neurochirurgie, hôpital Foch, 40, rue Worth, 92150 Suresnes, France.
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Aoyama T, Hida K, Ishii N, Seki T, Ikeda J, Iwasaki Y. Intramedullary spinal cord germinoma--2 case reports. ACTA ACUST UNITED AC 2006; 67:177-83; discussion 183. [PMID: 17254883 DOI: 10.1016/j.surneu.2006.05.062] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2006] [Accepted: 05/23/2006] [Indexed: 11/23/2022]
Abstract
BACKGROUND Primary intramedullary spinal cord germinoma is very rare. We encountered 2 patients with primary intramedullary spinal cord germinoma. We describe herein our comprehensive management system for CNS germinoma, including intramedullary spinal cord germinoma, along with a review of the literature. This is the first report to describe successful application of ICE chemotherapy for intramedullary germinoma. CASE DESCRIPTIONS A 16-year-old adolescent girl (case 1) experienced lumbago and subsequently noticed gait disturbance that aggravated gradually. On admission, paraparesis and urinary retention were noted. Magnetic resonance imaging demonstrated marked cord swelling between T9 and T12, with slight enhancement in the spinal cord. Astrocytic tumor was initially suspected, and partial removal was performed. However, pathologic examination identified germinoma. Successful treatment with ICE chemotherapy and radiotherapy was implemented, with no evidence of recurrence apparent at 48 months postoperatively. A 34-year-old woman (case 2) presented with paraparesis and sensory disturbance. Magnetic resonance imaging demonstrated cord swelling between T8 and T10, with slight Gd-DTPA enhancement. Because the lesion did not respond to steroid pulse therapy, spinal cord tumor was suspected and biopsy was performed. Pathologic examination verified primary germinoma of the spine. Successful treatment with ICE chemotherapy and radiotherapy was implemented with no exacerbation of neurologic deficits. No evidence of recurrence was apparent at 36 months postoperatively. CONCLUSION Correct diagnosis of very rare primary intramedullary spinal cord germinoma is important, because these patients can be treated successfully using chemo- and radiotherapy without neurologic deterioration.
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Affiliation(s)
- Takeshi Aoyama
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo 060-8636, Japan.
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Mikami-Terao Y, Akiyama M, Yanagisawa T, Takahashi-Fujigasaki J, Yokoi K, Fukuoka K, Sakuma M, Miyata I, Fujisawa K, Oi S, Eto Y. Lymphocytic hypophysitis with central diabetes insipidus and subsequent hypopituitarism masking a suprasellar germinoma in a 13-year-old girl. Childs Nerv Syst 2006; 22:1338-43. [PMID: 16565852 DOI: 10.1007/s00381-006-0078-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2005] [Indexed: 10/24/2022]
Abstract
CASE REPORT We report a case of central diabetes insipidus, hypothyroidism, and subsequent hypopituitarism due to lymphocytic hypophysitis masking a germinoma in a 13-year-old pubertal girl. Magnetic resonance revealed an enlarged pituitary gland and a mass lesion in the pituitary stalk and inferior hypothalamus. Open cranial surgery of the anterior pituitary showed active hypophysitis with lymphocytic infiltrates but without necrosis. Despite prednisolone therapy, 1 year later an enlarged, irregular cystic mass lesion had developed; in the pituitary stalk and inferior hypothalamus, a endoscopic biopsy revealed germinoma. CONCLUSION Lymphocytic hypophysitis in children may be the first sign of a host reaction to an occult germinoma. The diagnosis of central diabetes insipidus with a thickened pituitary stalk requires long-term follow-up to establish the underlying cause.
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Affiliation(s)
- Yoko Mikami-Terao
- Department of Pediatrics, Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan
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Cuccia V, Galarza M. Pure pineal germinomas: analysis of gender incidence. Acta Neurochir (Wien) 2006; 148:865-71; discussion 871. [PMID: 16791430 DOI: 10.1007/s00701-006-0846-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2005] [Accepted: 03/22/2006] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Pure pineal germinomas have been rarely reported in girls. Gender incidence and differences of pure pineal germinomas are not well known. The authors report a series of pure pineal germinoma and its gender characteristic is reviewed. METHODS AND RESULTS Of a total of 50 germ cell tumors operated on between 1988 and 2004 we found 26 cases (median age at diagnosis, 12 years) of pineal germ cell tumors. Of these, 14 cases (male/female ratio: 13/1) were pure pineal germinomas, and 12 cases (male/female ratio: 12/0) were non-germinoma germ cell tumors. In pure pineal germinomas, the main clinical presentations were intracranial hypertension and cranial nerve dysfunction. Imaging studies disclosed a homogeneous type of tumor (n = 10) and associated hydrocephalus (n = 6). Cases were managed with biopsy and subsequent radiation therapy and chemotherapy. After a follow up of 10 years, pure germinoma cases have no neurological deficits and tumor recurrence. The literature on gender incidence of pure pineal germinomas is analyzed and possible causes are discussed. CONCLUSIONS Although rare, pure pineal germinoma can be found in female subjects. On the basis of the literature review, the male/female ratio in cases of pure pineal germinoma is between 5:1 and 22:1 (mean 14:1). In our series, the male/female ratio was 13:1.
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Affiliation(s)
- V Cuccia
- Department of Neurosurgery, National Pediatric Hospital, Buenos Aires, Argentina.
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Li CS. Intrasellar germinoma treated with low-dose radiation. Acta Neurochir (Wien) 2006; 148:795-9; discussion 799. [PMID: 16670838 DOI: 10.1007/s00701-006-0776-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2005] [Accepted: 02/26/2006] [Indexed: 11/26/2022]
Abstract
A radiation dose lower than what had previously been recommended was given to a case of intrasellar germinoma in a 17-year-old patient who suffered from migraine-like headache for 2 years, amenorrhoea for 3 months and a body-weight loss of 10 kg over 4 months. Baseline assessment of pituitary hormone reserve was within the lower limits of the normal range, except for an elevated serum prolactin level (PRL). Magnetic resonance imaging (MRI) showed an abnormal, slightly enhanced mass in the pituitary fossa, extending along the pituitary stalk and to the hypothalamus. Transsphenoidal removal of the intrasellar part of the tumour was performed and microscopic sections of the surgical specimens revealed a pure germinoma. Adjunctive radiation therapy (RT) was given 3 weeks after surgery. A total dose of only 27 Gy was delivered to this patient. The patient's menstrual cycles resumed in 4 months. Repeated MRI follow-up showed no recurrence of the tumour.
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Affiliation(s)
- C S Li
- Neurosurgical Service, Kuang Tien General Hospital, Taiwan.
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Abstract
We report the case of a 28-year-old young man who presented with progressive paraparesis and urinary incontinence. Initial spinal MR scans showed a sausage-like lesion that extended between L1 and S2. At surgery, an encapsulated intradural extramedullary tumor was removed en bloc. The initial histopathological diagnosis was ependymoma. The tumor recurred locally to double its original size only 4 months later. After second surgery, 5,100 cGy of local spinal radiation was given since the pathologist believed that the new tumor exhibited anaplastic features. Subsequently tumor recurred at T6-10 levels and later in the right parasellar region. Surgery was undertaken for both recurrences and radiation to whole spine and to whole brain respectively followed surgery. At 11 months after the initial presentation, a new tumor was diagnosed at T11-T12 levels. After fifth surgery, chemotherapy with cisplatin, doxorubicin and vincristine was started. At this stage, review of all five surgical specimens by an outside neuropathologist was considered crucial. The new and correct histological diagnosis was germinoma. A new chemotherapy regimen targeted for germinoma was then started. The patient remains alive with no evidence of disease at 22 months after initial presentation. Primary spinal germinomas are exceedingly rare. A review of the literature revealed only 14 biopsy-proven spinal germinoma cases. Our case is clearly unique in aggressivity of the tumor, a feature often unexpected for germinomas. This case proves that the dissemination risk may be very serious for germinomas and that the craniospinal radiation may be a more secure treatment mode.
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Ghirardello S, Malattia C, Scagnelli P, Maghnie M. Current perspective on the pathogenesis of central diabetes insipidus. J Pediatr Endocrinol Metab 2005; 18:631-45. [PMID: 16128239 DOI: 10.1515/jpem.2005.18.7.631] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Diabetes insipidus is a heterogeneous condition characterised by polyuria and polydipsia caused by a lack of secretion of vasopressin, its physiological suppression following excessive water intake, or kidney resistance to its action. The clinical and laboratory diagnosis is confirmed by standard tests, but recent advances in molecular biology and imaging techniques have shed new light on the pathophysiology of this disease. In many patients, central diabetes insipidus is caused by a germinoma or craniopharyngioma; Langerhans' cell histiocytosis and sarcoidosis of the central nervous system; local inflammatory, autoimmune or vascular diseases; trauma from surgery or accident; and, rarely, genetic defects in vasopressin biosynthesis inherited as autosomal dominant or X-linked recessive traits. Thirty to fifty percent of cases are considered idiopathic. Tumour-associated central diabetes insipidus is uncommon in children younger than 5 years old. Biopsy of enlarged pituitary stalk should be reserved for patients with hypothalamic-pituitary mass and progressive thickening of the pituitary stalk since spontaneous recovery may occur. Molecular biology in selected patients may identify those with apparently idiopathic diabetes insipidus carrying the vasopressin-neurophysin II gene mutation.
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Affiliation(s)
- Stefano Ghirardello
- Department of Pediatrics, IRCCS Policlinico S Matteo, University of Pavia, Pavia, Italy
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Bauditz J, Ventz M, van Landeghem F, Lochs H. [Hypogonadism despite of normal testosterone levels]. Internist (Berl) 2005; 46:334-40. [PMID: 15702303 DOI: 10.1007/s00108-004-1326-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
We report on a 19 year old patient with clinical signs of hypogonadism (small testicles, missing pollutions and diminished beard growth) despite of normal testosterone levels. Further diagnostic procedures revealed panhypopituitarism with insufficiency of the gonadotrope, somatotrope and corticotrope axis due to a beta-HCG-producing suprasellar germinoma with intracerebral metastases. Paraneoplastic production of beta-HCG resulted in sufficient stimulation of Leydig cells with normal production of testosterone, which had partly masked clinical symptoms of gonatrope insufficiency. The patient was treated by combined radiochemotherapy and is in remission since 7 years.
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Affiliation(s)
- J Bauditz
- Medizinische Klinik und Poliklinik, Universitätsklinikum Charité Campus Mitte, Berlin.
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Affiliation(s)
- Ph Chanson
- Service d'Endocrinologie et des Maladies de la Reproduction, Hôpital Bicêtre, 78 rue du Général Leclerc, 94275 Le Kremlin-Bicêtre
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Huang JH, Tsui I, Judkins AR, Simon E, Birknes JK, Sutton LN. Intramedullary Cervical Spine Germinoma: Case Report. Neurosurgery 2004. [DOI: 10.1227/01.neu.0000143146.29632.38] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Abstract
OBJECTIVE AND IMPORTANCE:
We report an extremely rare case of primary intramedullary germinoma in the cervical spinal cord arising in an 18-year-old man who had not undergone previous surgery or irradiation.
CLINICAL PRESENTATION:
The patient had a 2-month history of intermittent neck pain and a 4-week history of bilateral hand paresthesias and weakness. A magnetic resonance imaging scan demonstrated a heterogeneous cervical spine lesion with marked contrast enhancement extending from C3 to C6.
INTERVENTION:
The patient underwent a cervical laminotomy with tumor resection, and pathological examination revealed the tumor to be a germinoma. He recovered well from the surgery with minimal neurological deficits. A postoperative magnetic resonance imaging scan of the brain and spinal cord did not show any other tumors. In addition, imaging studies of the mediastinum, testes, and the rest of the body also did not demonstrate any other tumors. The patient received local radiation as well as three courses of chemotherapy.
CONCLUSION:
To our knowledge, this is the first report of an intramedullary cervical spine germinoma with confirmed tissue diagnosis. Although extremely uncommon, the possibility of germinoma should be included in the differential diagnosis for primary intramedullary spinal cord tumors.
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Affiliation(s)
- Jason H. Huang
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Irena Tsui
- School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Alexander R. Judkins
- Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Erin Simon
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - John K. Birknes
- Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Leslie N. Sutton
- Division of Neurosurgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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Nongerminomatous Germ Cell Tumor of the Pineal Gland Causing Gonadotropin-Independent Precocious Puberty in a Child With 47, XYY Karyotype. ACTA ACUST UNITED AC 2004. [DOI: 10.1097/01.ten.0000139000.64137.60] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Reddy AT, Wellons JC, Allen JC, Fiveash JB, Abdullatif H, Braune KW, Grabb PA. Refining the staging evaluation of pineal region germinoma using neuroendoscopy and the presence of preoperative diabetes insipidus. Neuro Oncol 2004; 6:127-33. [PMID: 15134627 PMCID: PMC1871986 DOI: 10.1215/s1152851703000243] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2003] [Accepted: 12/03/2003] [Indexed: 11/19/2022] Open
Abstract
Treatment strategies for CNS germinoma are currently evolving. Current approaches include reducing the volume and dose of radiation by adding pre-irradiation chemotherapy. Very accurate staging is necessary with such an approach to prevent failures. Eight consecutive patients with pineal germinoma at one institution underwent endoscopic surgery for tumor biopsy, direct visualization of the third ventricular region, and third ventriculostomy for those with hydrocephalus. All patients were treated with 4 cycles of chemotherapy. Conformal field radiation therapy followed, with the dose to the tumor bed dependent on the response to chemotherapy. Patients who had MRI, endoscopic, or cerebrospinal fluid evidence of multicentric or disseminated disease also received craniospinal radiation. Six patients had diabetes insipidus (DI) at presentation. All 6 had tumor studding the floor of the third ventricle on endoscopic visualization, while only 4 of those patients had MRI evidence of disease in that region. All patients have completed therapy and are alive, with no evidence of disease at median follow-up of 31.5 months from diagnosis. Direct endoscopic visualization of the third ventricular region may be more sensitive than MRI for evaluating the presence of suprasellar disease and appears to add important information. This parameter should be added to the staging evaluation when feasible. In this series, the presence of DI was 100% predictive of suprasellar disease, even when the MRI was negative for involvement of that region. Patients should be evaluated for DI as part of the initial staging, and if it is present, the patients should be treated for suprasellar disease regardless of MRI findings.
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Affiliation(s)
- Alyssa T Reddy
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL 35233, USA.
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Nadkarni TD, Fattepurkar SC, Desai KI, Goel A. Intracranial optic nerve germinoma. J Clin Neurosci 2004; 11:559-61. [PMID: 15177413 DOI: 10.1016/j.jocn.2004.02.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2003] [Accepted: 02/14/2004] [Indexed: 11/25/2022]
Abstract
A 11-year-old boy presented with complaints of diminution of vision in the left eye for three months. On examination, the vision in this eye was reduced to only perception of light. Magnetic resonance imaging revealed a thickened left intracranial optic nerve. The lesion was explored by a pterional craniotomy. At surgery, the left optic nerve was diffusely thickened. The biopsy of a fleshy mass along the optic nerve showed that it was a germinoma on histopathology. Isolated optic nerve germinomas are extremely rare. Exclusive primary involvement of the intracranial portion of the optic nerve by a germinoma has not been reported in the literature. This rare case is discussed and the relevant literature has been reviewed.
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Hadjikoutis S, Hughes T. Germinoma with synchronous involvement of the pineal gland and the suprasellar region: a treatable cause of visual failure in a young adult. Eye (Lond) 2004; 18:525-6. [PMID: 15131686 DOI: 10.1038/sj.eye.6700715] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Germinomas constitute 0.1-3.4% of all intracranial tumours and 90% affect patients less than 20 years old. Although they are relatively aggressive tumours, which commonly invade the surrounding tissue and seed within the central nervous system, they are very radiosensitive and carry a favourable prognosis. We describe a 19-year-old man who presented with bilateral visual failure secondary to a germinoma with synchronous involvement of the pineal gland and the suprasellar region. Radiotherapy restored his vision almost back to normal.
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Affiliation(s)
- S Hadjikoutis
- Department of Neurology, University Hospital of Wales, Cardiff, UK.
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Chute DJ, Burton EC, Klement IA, Frazee JG, Vinters HV. Primary intramedullary spinal cord germinoma: case report. J Neurooncol 2003; 63:69-73. [PMID: 12814257 DOI: 10.1023/a:1023789806797] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
We describe an 18-year-old male with an intramedullary spinal cord germinoma in whom the diagnosis was made two years after onset of a progressive myelopathy. Spinal cord germinomas are rare, most having been described in young Japanese adults. They often respond well to radiotherapy. A unique feature of this case was the prolonged time interval between onset of the patient's symptoms and ability to visualize the mass radiographically. A further interesting finding was the infiltrative nature of the tumor surrounding residual spinal cord neurons.
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Affiliation(s)
- Dennis J Chute
- Department of Pathology and Laboratory Medicine, UCLA Medical Center, Los Angeles, CA 90095, USA.
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50
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Ferreira AJA, Peleteiro MC, Carvalho T, Correia JMJ, Schulman FY, Summers BA. Mixed germ cell tumour of the spinal cord in a young dog. J Small Anim Pract 2003; 44:81-4. [PMID: 12622473 DOI: 10.1111/j.1748-5827.2003.tb00125.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A spinal cord mixed germ cell tumour was identified in a two-year-old, female Airedale terrier with a history of progressive paraplegia. At necropsy, a discrete pale pink spinal cord mass was identified at the L5 vertebra, which extensively invaded the associated spinal cord segments L6 and L7. Histologically, the tumour was located within the subarachnoid space and invaded the spinal cord. It was composed of three different types of cells: small round cells, forming clusters or islands, similar to germ cells identified in testicular germinomas; large cells with eosinophilic or amphophilic cytoplasm, forming trabeculae; and a third, rarer type of well differentiated epithelial cells, forming acinar or tubular structures. Immunohistochemical examination revealed reactivity to antibodies against alpha-fetoprotein and broad spectrum cytokeratins. The composition, cytological features and immunohistochemical staining of this neoplasm are similar to germ cell tumours previously reported in the suprasellar region and in the eye of dogs.
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Affiliation(s)
- A J A Ferreira
- Centro de Investigação Interdisciplinar em Sanidade Animal, Faculdade de Medicina Veterinária, Rua Prof. Cid dos Santos 1300-477, Lisboa, Portugal
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