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Kano S, Matsuki M, Furukawa R, Nakata W, Oguma H, Gomi A, Mori H. A case of germinoma located in the fornix inducing transsynaptic atrophy of the Papez circuit. Radiol Case Rep 2023; 18:405-409. [DOI: 10.1016/j.radcr.2022.10.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 10/17/2022] [Accepted: 10/23/2022] [Indexed: 11/19/2022] Open
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MRI-based diagnosis and treatment of pediatric brain tumors: is tissue sample always needed? Childs Nerv Syst 2021; 37:1449-1459. [PMID: 33821340 PMCID: PMC8084800 DOI: 10.1007/s00381-021-05148-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 03/24/2021] [Indexed: 11/23/2022]
Abstract
Traditional management of newly diagnosed pediatric brain tumors (PBTs) consists of cranial imaging, typically magnetic resonance imaging (MRI), and is frequently followed by tissue diagnosis, through either surgical biopsy or tumor resection. Therapy regimes are typically dependent on histological diagnosis. To date, many treatment regimens are based on molecular biology. The scope of this article is to discuss the role of diagnosis and further treatment of PBTs based solely on MRI features, in light of the latest treatment protocols. Typical MRI findings and indications for surgical biopsy of these lesions are described.
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Dell'Aversana S, Coppola M, Romeo V, Ugga L, Piccin L, Sirignano C, D'Amico A, Soscia E, Matano E, D'Armiento FP, Del Basso De Caro M, Camera L, Maurea S. Germ cell tumors in male patients without gonadal involvement: computed tomography/magnetic resonance imaging findings and diagnostic workflow. Quant Imaging Med Surg 2019; 9:2000-2007. [PMID: 31929974 DOI: 10.21037/qims.2019.11.01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Serena Dell'Aversana
- Department of Advanced Biomedical Sciences, Oncology Division, University of Naples Federico II, Naples, Italy
| | - Milena Coppola
- Department of Advanced Biomedical Sciences, Oncology Division, University of Naples Federico II, Naples, Italy
| | - Valeria Romeo
- Department of Advanced Biomedical Sciences, Oncology Division, University of Naples Federico II, Naples, Italy
| | - Lorenzo Ugga
- Department of Advanced Biomedical Sciences, Oncology Division, University of Naples Federico II, Naples, Italy
| | - Luisa Piccin
- Department of Clinical Medicine and Surgery, Oncology Division, University of Naples Federico II, Naples, Italy
| | - Cesare Sirignano
- Institute of Biostructures and Bioimaging of the National Research Council (CNR), Naples, Italy
| | - Alessandra D'Amico
- Department of Advanced Biomedical Sciences, Oncology Division, University of Naples Federico II, Naples, Italy
| | - Ernesto Soscia
- Institute of Biostructures and Bioimaging of the National Research Council (CNR), Naples, Italy
| | - Elide Matano
- Department of Clinical Medicine and Surgery, Oncology Division, University of Naples Federico II, Naples, Italy
| | - Francesco Paolo D'Armiento
- Department of Advanced Biomedical Sciences, Oncology Division, University of Naples Federico II, Naples, Italy
| | | | - Luigi Camera
- Department of Advanced Biomedical Sciences, Oncology Division, University of Naples Federico II, Naples, Italy
| | - Simone Maurea
- Department of Advanced Biomedical Sciences, Oncology Division, University of Naples Federico II, Naples, Italy
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Guedes BF, Souza MNP, Barbosa BJAP, Frassetto FP, Lucato LT, Ono CR, Castro LHM, Nitrini R, Simabukuro MM. Intracranial germinoma causing cerebral haemiatrophy and hypopituitarism. Pract Neurol 2018; 18:306-310. [DOI: 10.1136/practneurol-2017-001771] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2018] [Indexed: 11/03/2022]
Abstract
A young woman presented with primary amenorrhoea, progressive haemiparesis, visual disturbance, dementia and focal motor seizures. Investigations showed hypopituitarism, unilateral cerebral atrophy and inflamed cerebrospinal fluid. A trans-sphenoidal biopsy gave a unifying diagnosis of a pituitary germinoma.
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Wei XH, Shen HC, Tang SX, Gao CH, Ren JL, Ai L, Dai JP. Radiologic features of primary intracranial ectopic germinomas: Case reports and literature review. Medicine (Baltimore) 2016; 95:e5543. [PMID: 28033250 PMCID: PMC5207546 DOI: 10.1097/md.0000000000005543] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Germinomas are sensitive to radiation therapy and chemotherapy; therefore, correct imaging diagnosis is crucial for them. However, the imaging findings of germinomas originating from off-midline regions displayed different patterns from those originating from midline areas. PATIENT CONCERNS The objective of this study is to describe the radiologic features of primary ectopic germinoma. We reviewed the MR and CT findings of 12 patients with histologically proven off-midline ectopic germinomas with off-midline locations. INTERVENTIONS All of these patients underwent conventional MR images and 3 of them underwent diffusion images. Additional CT images were available in 3 patients. Analysis was focused on the shape and entity of tumors in images, signs of hemiatrophy, and the involvement of fibers in diffusion images. OUTCOMES Well-defined (8/12) and ill-defined margin masses (4/12) were identified according to the shape of the mass. Multicystic masses were seen in 11 of the 12 patients. The solid component of the tumors had a high density (3/3) with calcifications (2/3) on CT images, iso- to hypointensity in T2WI (11/12) and restricted diffusion on apparent diffusion coefficient (ADC) maps (3/3). Hemiatrophy was observed in 5 cases and progressive hemiatrophy was observed in 1 case. Other signs included mild peritumoral edema (10/12), and hydrocephalus (7/12). Additionally, infiltration of the corticospinal tract (CST) was identified on diffusion tensor imaging (DTI) (2/2). LESSONS The results indicate that multicysitic entities and hypointensities in solid components on T2WI and hemiatrophy are the imaging features of ectopic germinomas. DTI has potential for assessing CST involvement.
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Affiliation(s)
- Xin-Hua Wei
- Department of Radiology, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, Guangdong
| | - Hui-Cong Shen
- Department of Neuroradiology, Tiantan Hospital, Beijing, China
| | - Shou-Xian Tang
- Department of Neuroradiology, Tiantan Hospital, Beijing, China
| | - Cui-Hua Gao
- Department of Radiology, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, Guangdong
| | - Ji-Liang Ren
- Department of Radiology, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, Guangdong
| | - Lin Ai
- Department of Neuroradiology, Tiantan Hospital, Beijing, China
| | - Jian-Ping Dai
- Department of Neuroradiology, Tiantan Hospital, Beijing, China
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Konovalov AN, Kadyrov SU, Tarasova EM, Mazerkina NA, Gorelyshev SK, Khukhlaeva EA, Kobyakov GL, Trunin YY, Sanakoeva AV, Kholodov BV, Shishkina LV, Panina TN, Ryzhova MV. Basal ganglia germinomas in children. Four clinical cases and a literature review. ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2016; 80:71-82. [PMID: 27029333 DOI: 10.17116/neiro201680171-82] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
UNLABELLED Basal ganglia germinomas are a specific group of intracranial germinomas. Their early diagnosis is complicated due to their atypical localization and diversity of neuroimaging and clinical signs. MATERIAL AND METHODS We describe 4 cases of basal ganglia germinoma in boys of 13, 14, 15, and 16 years of age. The medical history data, clinical features, neuroimaging and histological characteristics of basal ganglia germonomas, and preliminary results of the treatment are presented. CONCLUSION Basal ganglia germinomas are usually verified at the late stage of the disease when patients are detected with extended lesions of the basal ganglia and severe neurological and neuroendocrine deficits. This situation is due to clinical and imaging signs that are untypical of common germinomas.
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Affiliation(s)
| | - Sh U Kadyrov
- Burdenko Neurosurgical Institute, Moscow, Russia
| | - E M Tarasova
- Burdenko Neurosurgical Institute, Moscow, Russia
| | | | | | | | - G L Kobyakov
- Burdenko Neurosurgical Institute, Moscow, Russia
| | - Yu Yu Trunin
- Burdenko Neurosurgical Institute, Moscow, Russia
| | | | - B V Kholodov
- Burdenko Neurosurgical Institute, Moscow, Russia
| | | | - T N Panina
- Burdenko Neurosurgical Institute, Moscow, Russia
| | - M V Ryzhova
- Burdenko Neurosurgical Institute, Moscow, Russia
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Wataya T, Ishizaki R, Kitagawa M, Tashiro Y. Germinoma in the bilateral basal ganglia presented with cognitive deterioration. Childs Nerv Syst 2015; 31:953-8. [PMID: 25577220 DOI: 10.1007/s00381-015-2616-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Accepted: 01/02/2015] [Indexed: 01/10/2023]
Abstract
PURPOSE Here, we report a case of pediatric germinoma located in the bilateral basal ganglia, which presented with severe cognitive deteriorations. CASE REPORT A 15-year-old boy presented with decreased school performance and mild cognitive disturbances. Magnetic resonance images (MRI) of the brain revealed T2 hyperintensity in the bilateral basal ganglia. The patient was initially observed by a local hospital and had screening for metabolic diseases or inflammatory diseases. Lesions with similar characteristics were also found in the pituitary stalk and infundibulum, and these lesions were enhanced with gadolinium (Gad). MR spectroscopy suggested that these should be neoplastic lesions other than metabolic or inflammatory diseases. Biopsy was performed with ventriculoscope, which proved all lesions of infundibulum, pineal, and basal ganglia were pathologically germinoma. The lesions responded well to the chemotherapy and radiation, and his cognitive function improved significantly. CONCLUSION A case of germinoma in the bilateral basal ganglia which significantly affect cognitive functions is reported. Differential diagnoses of cognitive symptoms are various, but germinoma could be considered as a possible pathology for it. Early MRI and tumor marker exams are recommended, unless organic brain diseases are completely denied. MR spectroscopy and biopsy with ventriculoscope are useful for diagnosis.
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Affiliation(s)
- Takafumi Wataya
- Department of Neurosurgery, Shizuoka Children's Hospital, 860 Urushiyama, Aoi-ku, Shizuoka, 420-8660, Japan,
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Clinical use of (11)C-methionine and (18)F-FDG-PET for germinoma in central nervous system. Ann Nucl Med 2013; 28:94-102. [PMID: 24272066 PMCID: PMC3926980 DOI: 10.1007/s12149-013-0787-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2013] [Accepted: 11/03/2013] [Indexed: 11/09/2022]
Abstract
Objective The purpose of this study was to examine the 11C-methionine (MET) and 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) findings of central nervous system (CNS) germinoma and the diagnostic utility of these findings. Methods We retrospectively evaluated the cases of 10 patients who were diagnosed with CNS germinoma according to their histopathological or clinical findings. All the patients underwent pretreatment MET and/or FDG-PET scans, and the resultant images were assessed qualitatively and quantitatively. In the qualitative assessments, we used 3- and 5-grade visual scoring systems for the MET- and FDG-PET images, respectively. In the quantitative assessments, the maximal standardized uptake value (SUVmax) and the ratio of the SUVmax of the tumor (T) divided by the mean SUV for the normal white or gray matter [T/N (WM), T/N (GM)], was calculated. Results The mean and SD values of SUVmax, T/N (WM), and T/N (GM) were 1.9 ± 1.4, 2.5 ± 1.3, and 1.7 ± 0.9 on MET-PET and 5.8 ± 2.2, 1.6 ± 0.5, and 0.8 ± 0.2 on FDG-PET, respectively. On MET-PET, only one lesion was not detected. On the other hand, on FDG-PET all of the lesions exhibited uptake values that were intermediate between those of the normal white matter and gray matter. Conclusion In terms of its tumor-contouring ability, MET is a good tracer for diagnosing CNS germinomas; therefore, MET-PET is considered to be useful for planning biopsies or surgery. Although FDG-PET is capable of detecting CNS germinomas, it produced insufficient image contrast in the present study. Further studies are needed before FDG-PET can be used in clinical examinations of CNS germinoma.
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Goswami S, Chakraborty PP, Bhattacharjee R, Roy A, Thukral A, Selvan C, Ghosh S, Mukhopadhyay S, Chowdhury S. Precocious puberty: A blessing in disguise! Indian J Endocrinol Metab 2013; 17:S111-S113. [PMID: 24251126 PMCID: PMC3830272 DOI: 10.4103/2230-8210.119522] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Germ cell tumors may lead to incomplete isosexual male precocity and are commonly located in the pineal gland. Germinomas of the basal ganglia are almost always unilateral and precocious puberty is a rare manifestation in them. We report a 9.5-year-old boy who presented with incomplete isosexual precocity due to bilateral basal ganglia germinoma.
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Affiliation(s)
- Soumik Goswami
- Department of Endocrinology and Metabolism, IPGME and R and SSKM Hospital, Kolkata, West Bengal, India
| | - Partha Pratim Chakraborty
- Department of Endocrinology and Metabolism, IPGME and R and SSKM Hospital, Kolkata, West Bengal, India
| | - Rana Bhattacharjee
- Department of Endocrinology and Metabolism, IPGME and R and SSKM Hospital, Kolkata, West Bengal, India
| | - Ajitesh Roy
- Department of Endocrinology and Metabolism, IPGME and R and SSKM Hospital, Kolkata, West Bengal, India
| | - Anubhav Thukral
- Department of Endocrinology and Metabolism, IPGME and R and SSKM Hospital, Kolkata, West Bengal, India
| | - Chitra Selvan
- Department of Endocrinology and Metabolism, IPGME and R and SSKM Hospital, Kolkata, West Bengal, India
| | - Sujoy Ghosh
- Department of Endocrinology and Metabolism, IPGME and R and SSKM Hospital, Kolkata, West Bengal, India
| | - Satinath Mukhopadhyay
- Department of Endocrinology and Metabolism, IPGME and R and SSKM Hospital, Kolkata, West Bengal, India
| | - Subhankar Chowdhury
- Department of Endocrinology and Metabolism, IPGME and R and SSKM Hospital, Kolkata, West Bengal, India
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Uduma FU, Emejulu JKC, Motah M, Okere PCN, Ongolo PC, Muna W. Differential diagnoses of cerebral hemiatrophy in childhood: a review of literature with illustrative report of two cases. Glob J Health Sci 2013; 5:195-207. [PMID: 23618490 PMCID: PMC4776813 DOI: 10.5539/gjhs.v5n3p195] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Accepted: 12/20/2012] [Indexed: 12/28/2022] Open
Abstract
Childhood cerebral hemiatrophy is an uncommon clinical entity. Its aetiologies are diverse but can generally be grouped into congenital and acquired. The congenital type is intrauterine in origin while the acquired type occurs early in life, usually before two year of life. When childhood cerebral hemiatrophy occurs, it evokes a spectrum of compensatory calvarial sequlae. These include ipsilateral calvarial thickening, diploe widening, hyper-pneumatization of paranasal sinues/ mastoids, elevation of petrous bone and small middle cranial fossa. MRI is very effective in high lightening brain atrophy, associated parenchymal changes and even the above enumerated skull changes. Our two case reports of left hemi-cerebral atrophy in male Cameroonian children seen in our MRI practice aptly demonstrated some of the aforementioned radiological features of childhood cerebral hemiatrophy noted in literature review.
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Affiliation(s)
- Felix Uduma Uduma
- Department of Radiology, Faaculty of Clinical Sciences, University of Uyo, Nigeria.
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Takeshima Y, Yamada S, Motoyama Y, Park YS, Nakase H. An unusual case of primary central nervous system germinoma with meningeal dissemination. Childs Nerv Syst 2012; 28:2173-6. [PMID: 22936081 DOI: 10.1007/s00381-012-1901-y] [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: 06/08/2012] [Accepted: 08/20/2012] [Indexed: 11/25/2022]
Abstract
PURPOSE Central nervous system germinomas often extend or disseminate into the ventricular and subarachnoid space. We present a case of primary central nervous system germinoma consisting mainly of meningeal dissemination, which is extremely unusual. CASE REPORT A 16-year-old boy presented with pure germinoma, manifesting as anorexia and headache for 10 days. Radiological examinations revealed a large mass lesion in the posterior fossa and a small mass lesion on the pineal lobule with thickening of the tentorium cerebelli and falx. The patient underwent partial removal of the infratentorial tumor via open surgery. Intraoperative findings indicated extension of the dural and supracerebellar mass lesions into the epiarachnoid space. Three chemotherapy courses comprising ifosfamide, etoposide, and cisplatin were administered after the surgery. Craniospinal irradiation was administered subsequently. The adjuvant therapy had a complete response. CONCLUSION Central nervous system germinoma cells may have similar compatibility to meningeal components as they do to cerebrospinal fluid or the ventricular system. If there is a possibility of the tumor extending into the subdural space during surgical intervention or other events, a range of postdiagnostic irradiation should be considered to cover a wider range.
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Affiliation(s)
- Yasuhiro Takeshima
- Department of Neurosurgery, Nara Medical University School of Medicine, 840 Shijo-cho, Kashihara, Nara 634-8521, Japan.
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Sadamura Y, Sugiyama K, Uchida H, Hanaya R, Eguchi K, Kurisu K, Arita K, Hirano H. Intracranial germinoma presenting with hemiatrophy--follow-up results and literature review--two case reports. Neurol Med Chir (Tokyo) 2011; 51:148-52. [PMID: 21358162 DOI: 10.2176/nmc.51.148] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Two boys aged 8 and 12 years presented with intracranial germinoma manifesting as cerebral hemispheric atrophy, hemiparesis, and decline in academic performance. First magnetic resonance (MR) imaging showed no enhanced lesions, but follow-up MR imaging obtained 12 or 23 months after the first visit showed new mass lesions in the temporal lobe or pituitary gland. Biopsy of these lesions resulted in a histological diagnosis of germinoma. Chemoradiation therapy produced complete remission but both patients continued to manifest mild hemiparesis and impaired cognitive function. Review of 18 previous and our 2 patients presenting with hemispheric atrophy revealed strong male predominance (18:2), mean age of 12.8 ± 5.2 (standard deviation) years, hemiparesis in all patients, and cognitive decline in 9 patients. Initial MR imaging detected mass lesions in only 9 patients, but follow-up MR imaging performed 10-38 months later detected new mass lesions in 5 patients. Radiation with/without chemotherapy provided good tumor control in all patients, but none of the 9 patients with cognitive dysfunction recovered their intellectual ability. We recommend early diagnosis based on biopsy of the atrophic site and timely treatment to improve the quality of life in these patients.
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Affiliation(s)
- Yuko Sadamura
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
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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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Phi JH, Cho BK, Kim SK, Paeng JC, Kim IO, Kim IH, Kim DG, Jung HW, Kim JE, Wang KC. Germinomas in the basal ganglia: magnetic resonance imaging classification and the prognosis. J Neurooncol 2010; 99:227-36. [DOI: 10.1007/s11060-010-0119-7] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2009] [Accepted: 01/04/2010] [Indexed: 02/06/2023]
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Pathophysiological mechanism of ipsilateral cerebral and brainstem hemiatrophy in basal ganglia germ cell tumors: case report. Childs Nerv Syst 2009; 25:693-9. [PMID: 19139902 DOI: 10.1007/s00381-008-0787-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2008] [Revised: 10/29/2008] [Indexed: 12/11/2022]
Abstract
INTRODUCTION The basal ganglia is an uncommon location for germ cell tumors. It has been reported that basal ganglia germinomas and mixed germ cell tumors are associated with ipsilateral cerebral and brainstem hemiatrophy on presentation. Several pathophysiological mechanisms including autoimmune process and direct tumor infiltration of the thalamus or the internal capsule have been postulated to explain this association. CASE REPORTS The authors report two boys, aged 7 and 10, with basal ganglia germ cell tumors. Both of them presented with gradual onset of hemiparesis and had features of ipsilateral cerebral and brainstem hemiatrophy on imaging studies. They underwent chemotherapy followed by reduced dose radiotherapy with good response. DISCUSSION Pathophysiological mechanisms of the associated ipsilateral cerebral and brainstem hemiatrophy are discussed. The authors postulate that the gradual obliteration of the perforating arteries to the diencephalon especially the lenticulostriate arteries of the prebifurcation middle cerebral artery may be the major mechanism of the associated hemiatrophy.
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Maruya J, Narita E, Nishimaki K, Heianna J, Miyauchi T, Minakawa T. Primary cystic germinoma originating from the midbrain. J Clin Neurosci 2009; 16:832-4. [PMID: 19299138 DOI: 10.1016/j.jocn.2008.08.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2008] [Revised: 08/17/2008] [Accepted: 08/19/2008] [Indexed: 11/29/2022]
Abstract
A primary intracranial germinoma that involves the midbrain is rare. We describe an unusual case of primary cystic germinoma originating from the midbrain. A 29-year-old man presented with diplopia, and his MRI showed a cystic, ring-like enhanced lesion in the thalamo-mesencephalic junction. Open biopsy was performed and the diagnosis of germinoma was based upon the histopathological findings. Following chemotherapy and radiotherapy, the symptoms improved and the tumor disappeared. We propose that primary intracranial germinoma should be included in the differential diagnosis of midbrain tumors, because early diagnosis and appropriate treatment for midbrain germinoma improves clinical outcome.
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Affiliation(s)
- Jun Maruya
- Department of Neurosurgery, Akita Red Cross Hospital, 222-1 Nawashirosawa, Saruta, Kamikitate, Akita 010-1495, Japan.
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Lee J, Lee BL, Yoo KH, Sung KW, Koo HH, Lee SJ, Choi JY, Lee KH, Lee JI, Shin HJ, Kim JH, Suh YL, Lee KH, Lee M. Atypical basal ganglia germinoma presenting as cerebral hemiatrophy: diagnosis and follow-up with 11C-methionine positron emission tomography. Childs Nerv Syst 2009; 25:29-37. [PMID: 18712399 DOI: 10.1007/s00381-008-0674-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2008] [Indexed: 12/19/2022]
Abstract
OBJECTS Some basal ganglia germinomas are difficult to diagnose in early stage of disease due to vague initial presentation without discernable mass lesion on brain imaging. We performed this study to determine the usefulness of 11C-methionine positron emission tomography (MET PET) for the diagnosis and monitoring of disease activity. MATERIALS AND METHODS MET PET was performed in three consecutive patients; they presented with cerebral hemiatrophy without definite mass lesions on brain image. The maximum standard tracer uptake values (max SUVs) were calculated and used for the quantitative evaluation of the abnormal MET uptake. A pathological diagnosis was made after stereotactic biopsy using MET PET/computed tomography. The max SUVs significantly decreased after treatment. CONCLUSION Basal ganglia germinoma should be considered in the differential diagnosis of patients with progressive hemiparesis and hemiatrophy on magnetic resonance imaging. The MET PET was useful for diagnosis, and it can be valuable in evaluation of treatment effects and monitoring for tumor recurrence.
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Affiliation(s)
- Jeehun Lee
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Mridula KR, Alladi S, Varma DR, Chaudhuri JR, Jyotsna Y, Borgohain R, Kaul S. Corticobasal syndrome due to a thalamic tuberculoma and focal cortical atrophy. BMJ Case Rep 2009; 2009:bcr08.2008.0820. [PMID: 21686613 DOI: 10.1136/bcr.08.2008.0820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Corticobasal syndrome (CBS) is characterised by asymmetric apraxia, cortical sensory loss, extrapyramidal features and cognitive decline. Although CBS is classically described as a taupathy, heterogeneity of its aetiology is increasingly recognised. Clinical presentation of CBS appears to reflect areas of the brain involved and not necessarily the nature of the underlying pathology. We report a patient in whom resolution of a thalamic tuberculoma was associated with progressive atrophy of the parietotemporal cortex, resulting in an unusual presentation of CBS.
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Affiliation(s)
- K R Mridula
- Department of Neurology, Nizam's Institute of Medical Sciences, Punjagutta, Hyderabad, India
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Villani A, Bouffet E, Blaser S, Millar BA, Hawkins C, Bartels U. Inherent diagnostic and treatment challenges in germinoma of the basal ganglia: a case report and review of the literature. J Neurooncol 2008; 88:309-14. [PMID: 18365143 DOI: 10.1007/s11060-008-9568-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2007] [Accepted: 03/04/2008] [Indexed: 12/12/2022]
Abstract
Among intracranial germinomas, basal ganglia germinomas represent a specific clinical and anatomical entity. Based on an unusual case of a basal ganglia germinoma in a 13-year-old Caucasian male, we highlight the diagnostic challenges and discuss treatment considerations in this disease.
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Affiliation(s)
- Anita Villani
- Division of Paediatrics, The Hospital for Sick Children, Toronto, Canada
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Rossi A, Garrè ML, Ravegnani M, Nozza P, Abbruzzese A, Giangaspero F, Tortori-Donati P. Bilateral germinoma of the basal ganglia. Pediatr Blood Cancer 2008; 50:177-9. [PMID: 16700048 DOI: 10.1002/pbc.20905] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Germinoma arising in the bilateral basal ganglia is exceedingly rare, with only five cases reported to date. Owing to non-specific clinical findings and the frequent presence of ill-defined abnormalities without a definite tumor mass on neuroimaging, the diagnosis can be difficult. We describe a case in which magnetic resonance spectroscopy (MRS) findings suggested a tumor and supported the decision to perform biopsy of the lesion.
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Affiliation(s)
- Andrea Rossi
- Department of Pediatric Neuroradiology, G. Gaslini Children's Hospital, Genoa, Italy.
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Sartori S, Laverda AM, Calderone M, Carollo C, Viscardi E, Faggin R, Perilongo G. Germinoma with synchronous involvement of midline and off-midline structures associated with progressive hemiparesis and hemiatrophy in a young adult. Childs Nerv Syst 2007; 23:1341-5. [PMID: 17609967 DOI: 10.1007/s00381-007-0390-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2006] [Revised: 03/21/2007] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Cerebral germinomas, the most common and least malignant intracranial germ cell tumors, usually arise in the pineal or suprasellar region and have characteristic clinical and radiological features. Germinomas more rarely occur in the thalamus, basal ganglia, and internal capsule, causing sometimes cerebral hemiatrophy and hemiparesis. More rarely, other clinical features can be fever of unknown origin, visual disturbance, and neuropsychiatric symptoms. Cerebral hemiatrophy can precede the imaging depiction of the off-midline mass. CASE The authors present the first case of cerebral germinoma with synchronous involvement of the midline and off-midline structures, with unusual clinical and radiological presentation. DISCUSSION The literature is reviewed, and the pathogenesis, the clinical findings, the imaging, and the therapy are discussed.
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Affiliation(s)
- S Sartori
- Department of Pediatrics, University of Padua, Via Giustiniani 3, 35128 Padua, Italy
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Ozelame RV, Shroff M, Wood B, Bouffet E, Bartels U, Drake JM, Hawkins C, Blaser S. Basal ganglia germinoma in children with associated ipsilateral cerebral and brain stem hemiatrophy. Pediatr Radiol 2006; 36:325-30. [PMID: 16463029 DOI: 10.1007/s00247-005-0063-4] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2005] [Revised: 10/24/2005] [Accepted: 10/31/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND Germinoma is the most common and least-malignant intracranial germ cell tumor, usually found in the midline. Germinoma that arises in the basal ganglia, called ectopic germinoma, is a rare and well-documented entity representing 5% to 10% of all intracranial germinomas. The association of cerebral and/or brain stem atrophy with basal ganglia germinoma on CT and MRI is found in 33% of the cases. OBJECTIVE To review the literature and describe the CT and MRI findings of basal ganglia germinoma in children, known as ectopic germinoma, with associated ipsilateral cerebral and brain stem hemiatrophy. MATERIALS AND METHODS Three brain CT and six brain MRI studies performed in four children at two institutions were retrospectively reviewed. All patients were male (case 1, 14 years; case 2, 13 years; case 3, 9 years; case 4, 13 years), with pathologically proved germinoma arising in the basal ganglia, and associated ipsilateral cerebral and/or brain stem hemiatrophy on the first imaging study. It is important to note that three of these children presented with cognitive decline, psychosis and slowly progressive hemiparesis as their indication for imaging. RESULTS Imaging results on initial scans were varied. In all patients, the initial study showed ipsilateral cerebral and/or brain stem hemiatrophy, representing Wallerian degeneration. All patients who underwent CT imaging presented with a hyperdense or calcified lesion in the basal ganglia on unenhanced scans. Only one of these lesions had a mass effect on the surrounding structures. In one of these patients a large, complex, heterogeneous mass appeared 15 months later. Initial MR showed focal or diffusely increased T2 signal in two cases and heterogeneous signal in the other two. CONCLUSION The association of a focal lesion in the basal ganglia of children with progressive hemiparesis, neuropsychiatric symptoms and ipsilateral cerebral and/or brain stem hemiatrophy should prompt the diagnosis of ectopic germinoma, avoiding delay in the diagnosis and further irreversible clinical deterioration, in a malignancy with an otherwise favorable prognosis. In these patients, hemiatrophy preceding or accompanying the imaging depiction of a basal ganglia mass lesion is thought to be caused by a paraneoplastic process.
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Affiliation(s)
- Rodrigo V Ozelame
- Department of Diagnostic Imaging, Hospital for Sick Children, 555 University Ave., Toronto, Ontario, Canada M5G 1X8.
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Takeda N, Fujita K, Katayama S, Uchihashi Y, Okamura Y, Nigami H, Hashimoto K, Kohmura E. Germinoma of the basal ganglia. An 8-year asymptomatic history after detection of abnormality on CT. Pediatr Neurosurg 2004; 40:306-11. [PMID: 15821363 DOI: 10.1159/000083745] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2004] [Accepted: 09/15/2004] [Indexed: 12/15/2022]
Abstract
We describe a case of germinoma of the left basal ganglia. An 11-year-old boy, who demonstrated calcification of the left basal ganglia on CT scan following a head injury at the age of 3 years, presented with a weakness of the right upper extremity for 2 months. MRI demonstrated high intensity in the left basal ganglia on a T1-weighted image without enhancement as well as high intensity on a T2-weighted image. Ipsilateral hemiatrophy of the hemisphere and midbrain was also noted. In addition, high intensity in the left internal capsule and cerebral peduncle was demonstrated on T2-weighted image. Surgical specimens obtained by stereotactic biopsy showed germinoma with a two-cell pattern. The patient had remained asymptomatic for 8 years after abnormal calcification was initially detected on CT scan. Ipsilateral hemiatrophy of the hemisphere and midbrain was demonstrated before the onset of weakness.
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Affiliation(s)
- Naoya Takeda
- Department of Neurosurgery, Nishi-Kobe Medical Center, Kobe, Japan.
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Parwani AV, Ali SZ. Pathologic quiz case: a 23-year-old man with headaches and visual difficulties. Arch Pathol Lab Med 2003; 127:497-8. [PMID: 12683885 DOI: 10.5858/2003-127-0497-pqcayo] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Anil V Parwani
- Department of Pathology, the Johns Hopkins Hospital, Baltimore, Md 21287, USA
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