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Primary midbrain germinomas: Report of a rare case with an updated review of the literature. Clin Neurol Neurosurg 2023; 227:107643. [PMID: 36863221 DOI: 10.1016/j.clineuro.2023.107643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 02/08/2023] [Accepted: 02/10/2023] [Indexed: 03/04/2023]
Abstract
Intracranial germinomas are most commonly extra-axial germ cell tumors that are predominantly found in the pineal and suprasellar regions. Primary intra-axial midbrain germinomas are extremely rare, with only eight reported cases. Here we present a 30-year-old man who presented with severe neurological deficits, with an MRI that showed a heterogeneously enhancing mass with ill-defined margins in the midbrain, and with surrounding vasogenic edema extending to the thalamus. The presumptive preoperative differential diagnosis included glial tumors and lymphoma. The patient underwent a right paramedian suboccipital craniotomy and biopsy obtained through the supracerebellar infratentorial transcollicular approach. The histopathological diagnosis was reported as pure germinoma. After patient discharge, he received chemotherapy with carboplatin and etoposide, followed by radiotherapy. Follow-up MRI at up to 26 months showed no contrast-enhancing lesions but a mild T2 FLAIR hyperintensity adjacent to the resection cavity. Differential diagnosis of midbrain lesions can be challenging and should include glial tumors, primary central nervous system lymphoma, germ cell tumors, and metastasis. Accurate diagnosis requires adequate tissue sampling. In this report, we present a very rare case of a primary intra-axial germinoma of the midbrain which is biopsied via a transcollicular approach. This report is also unique as it provides the first surgical video of an open biopsy and the microscopic appearance of an intra-axial primary midbrain germinoma via a transcollicular approach.
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Miyake Y, Tateishi K, Oshima A, Hongo T, Satomi K, Ichimura K, Kato A, Iwashita H, Utsunomiya D, Yamamoto T. A case of midbrain germinoma: A literature review for radiographic and clinical features. Neurooncol Adv 2023; 5:vdad043. [PMID: 37215953 PMCID: PMC10195201 DOI: 10.1093/noajnl/vdad043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2023] Open
Affiliation(s)
- Yohei Miyake
- Department of Neurosurgery, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Kensuke Tateishi
- Corresponding author: Kensuke Tateishi, MD, PhD, Department of Neurosurgery, Yokohama City University, 3-9 Fukuura, Kanazawa, Yokohama 2360004, Japan ()
| | - Akito Oshima
- Department of Neurosurgery, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Takeshi Hongo
- Department of Neurosurgery, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Kaishi Satomi
- Department of Pathology, Kyorin University School of Medicine, Tokyo, Japan
| | - Koichi Ichimura
- Deparment of Brain Disease Translational Research, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Ayumi Kato
- Department of Radiology, Yokohama City University Hospital, Yokohama, Japan
| | - Hiromichi Iwashita
- Department of Pathology, Yokohama City University Hospital, Yokohama, Japan
| | - Daisuke Utsunomiya
- Department of Radiology, Yokohama City University Hospital, Yokohama, Japan
| | - Tetsuya Yamamoto
- Department of Neurosurgery, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
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Oshima A, Kimura T, Akabane A, Inoue T. Primary midbrain germinoma relapse-free for 5 years: A case report. Surg Neurol Int 2022; 13:574. [PMID: 36600775 PMCID: PMC9805627 DOI: 10.25259/sni_703_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 11/24/2022] [Indexed: 12/15/2022] Open
Abstract
Background The biology and clinical course of intracranial germinomas differ as per their location of occurrence. Germinoma of the primary midbrain is particularly rare, and its clinical features, treatment strategies, and long-term prognosis remain uncertain. Case Description A 39-year-old man who had been diagnosed with midbrain germinoma by open biopsy through the occipital transtentorial approach had undergone chemoradiotherapy and achieved 5 years with no recurrence. Conclusion Germinomas should be considered as a differential diagnosis for adolescents and young adult men with mesencephalic tumors, and reliable sampling followed by chemoradiotherapy must be performed.
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Affiliation(s)
- Akito Oshima
- Department of Neurosurgery, NTT Medical Center Tokyo, Tokyo, Japan,Department Neurosurgery, Yokohama City University, Graduate School of Medicine, Fukuura, Kanazawa-ku, Yokohama, Japan,Corresponding author: Akito Oshima, Department of Neurosurgery, NTT Medical Center Tokyo, Tokyo, Japan.
| | - Toshikazu Kimura
- Department of Neurosurgery, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Atsuya Akabane
- Gamma Knife Center, NTT Medical Center Tokyo, Tokyo, Japan
| | - Tomohiro Inoue
- Department of Neurosurgery, NTT Medical Center Tokyo, Tokyo, Japan
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Bian J, Westrup A, Sung S, Anadani NA, Fung KM, Conner AK. Co-existence of multiple sclerosis and germinoma in an adult male: Case report. Surg Neurol Int 2021; 12:177. [PMID: 34084605 PMCID: PMC8168793 DOI: 10.25259/sni_867_2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 03/26/2021] [Indexed: 11/04/2022] Open
Abstract
Background Concurrent diagnosis of multiple sclerosis (MS) and the central nervous system (CNS) germinoma is rare. The diagnostic criteria for MS rely primarily on clinical presentation, and CNS germinoma can present as an MS mimic. These factors contribute to the rarity of dual diagnosis. Case Description A 28-year-old man presented initially with bilateral optic neuritis, manifesting as persistently worsening vision for 2 years, and demyelinating plaques identified within the corpus callosum on magnetic resonance imaging. Initial work-up, in addition to clinical presentation, led to diagnosis of MS. Three months following the diagnosis of MS, the patient then presented with obstructive hydrocephalus due to a newly diagnosed intraventricular mass. The patient underwent an endoscopic third ventriculostomy and biopsy which confirmed diagnosis of CNS germinoma. Conclusion To the best of our knowledge, dual presentation of both MS and CNS germinoma has never been reported in the literature. The clinical presentation of bilateral optic neuritis (persisting for roughly 2 years before initial MS diagnosis), demyelinating plaques, and intrathecal oligoclonal bands before the development of an intraventricular mass indicates that both MS and CNS germinoma presented simultaneously in this patient. The treatment plan for this patient included carboplatin + etoposide, followed by adjuvant radiation and subsequent IVIG therapy.
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Affiliation(s)
- Jan Bian
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States
| | - Alison Westrup
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States
| | - Sarah Sung
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States
| | - Nidhiben A Anadani
- Department of Neurology University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States
| | - Kar-Ming Fung
- Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States
| | - Andrew K Conner
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States
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Zhou Y, Vickers A, Chan NCY, Chan CKM, Urias E, Lee AG, Lo SSM, Trivedi D. Atypical presentations of intracranial dysgerminoma mimicking central nervous system inflammatory or demyelinating disease. Can J Ophthalmol 2019; 55:159-166. [PMID: 31712009 DOI: 10.1016/j.jcjo.2019.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 07/08/2019] [Accepted: 07/21/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The aim of this study is to report a case series of atypical presentations of intracranial dysgerminoma in which the diagnosis was delayed due to clinical and radiographic findings initially suggestive of CNS inflammatory or demyelinating diseases, such as MS. METHODS This study is a case series detailing the history, clinical presentations, radiographic and laboratory results, and management of three patients with biopsy-proven intracranial dysgerminoma. RESULTS All three patients demonstrated hyperintense lesions on MRI that were more suggestive of demyelinating or inflammatory diseases, including lesions involving the midbrain and corpus callosum. All three patients were serum positive for oligoclonal bands and negative for both AFP and beta-hCG (these two markers are commonly seen in dysgerminoma cases). One case involved a steroid-responsive tumor whereas the other two cases either did not respond to steroids or steroids were withheld due to uncertainty of etiology. Following biopsy, all three results were consistent with dysgerminoma. CONCLUSION Clinicians should be aware that dysgerminoma may mimic the clinical and radiographic presentations of demyelinating diseases such as MS. These lesions can cause acute visual loss or diplopia, have MRI and CSF findings that might mimic MS, and have been shown to respond to steroids. Atypical clinical (e.g., headache, dorsal midbrain syndrome, bilateral optic neuropathy) or atypical radiographic features (e.g., mass effect, hydrocephalus) should prompt consideration for repeat imaging and possible biopsy even if serum or CSF tumor markers (beta-hCG and AFP) are negative for dysgerminoma.
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Affiliation(s)
- You Zhou
- School of Medicine, University of Texas Medical Branch, Galveston, TX
| | - Aroucha Vickers
- Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, TX
| | - Noel C Y Chan
- Hong Kong Eye Hospital, and Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Kowloon, Hong Kong
| | - Carmen K M Chan
- Hong Kong Eye Hospital, and Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Kowloon, Hong Kong
| | - Elizabeth Urias
- Department of Ophthalmology, University of Texas Medical Branch, Galveston, TX
| | - Andrew G Lee
- School of Medicine, University of Texas Medical Branch, Galveston, TX; Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, TX; Department of Ophthalmology, University of Texas Medical Branch, Galveston, TX; Department of Ophthalmology, Baylor College of Medicine, Houston, TX, and UT MD Anderson Cancer Center, Houston, TX; Texas A and M College of Medicine, Bryan, TX; Departments of Ophthalmology, Neurology, and Neurosurgery, Weill Cornell Medicine, New York, NY; Department of Ophthalmology, The University of Iowa Hospitals and Clinics, Iowa City, IA.
| | - Sherman S M Lo
- Diagnostic Radiology and Imaging Department, Queen Elizabeth Hospital, Kowloon, Hong Kong
| | - Darshan Trivedi
- Department of Pathology, Houston Methodist Hospital, Houston, TX
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Romano A, Rigante D, Cipolla C. Autoimmune phenomena involving the pituitary gland in children: New developing data about diagnosis and treatment. Autoimmun Rev 2019; 18:102363. [PMID: 31401342 DOI: 10.1016/j.autrev.2019.102363] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Accepted: 03/30/2019] [Indexed: 11/27/2022]
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Purkart TU, Seifert-Held T, Haybäck J, Holl E, Asslaber M, Payer F, Fazekas F. Vanishing midbrain mass lesion - A germinoma? J Neurol Sci 2019; 404:40-43. [PMID: 31325666 DOI: 10.1016/j.jns.2019.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 05/24/2019] [Accepted: 06/12/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Tadeja Urbanic Purkart
- Department of Neurology and Neuroradiology, Vascular and Interventional Radiology, Auenbruggerplatz 22, 8036 Graz, Medical University of Graz, Austria.
| | - Thomas Seifert-Held
- Department of Neurology, Medical University of Graz, Auenbruggerplatz 22, 8036 Graz, Austria.
| | - Johannes Haybäck
- Department of Neuropathology, Medical University of Graz, Austria; Institute of Pathology, Neuropathology and Molecular Pathology, Medical University Innsbruck, Austria; Institute of Pathology, University Clincs Magdeburg, Medical Faculty, Germany.
| | - Etienne Holl
- Department of Neurosurgery, Medical University of Graz, Austria.
| | - Martin Asslaber
- Department of Neuropathology, Medical University of Graz, Austria.
| | - Franz Payer
- Department of Neurology and Neuroradiology, Vascular and Interventional Radiology, Auenbruggerplatz 22, 8036 Graz, Medical University of Graz, Austria.
| | - Franz Fazekas
- Department of Neurology, Medical University of Graz, Auenbruggerplatz 22, 8036 Graz, Austria.
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Pierzchlewicz K, Bilska M, Jurkiewicz E, Chmielewski D, Moszczyńska E, Daszkiewicz P, Ciołkowski M, Grajkowska W, Kotulska K. Germinoma Mimicking Brain Inflammation: A Case Report. Child Neurol Open 2019; 6:2329048X19848181. [PMID: 31259195 PMCID: PMC6591517 DOI: 10.1177/2329048x19848181] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Revised: 02/21/2019] [Accepted: 04/04/2019] [Indexed: 11/16/2022] Open
Abstract
The authors report a case of a germinoma of the brain in the child with symptoms restricted to central nervous system. Ten-year-old girl presented initially with sight deterioration, learning difficulties, abnormal behavior, polydipsia, and polyuria. Brain magnetic resonance examination revealed T2 hyperintensity of the corpus callosum, anterior commissure, and caudate nuclei. Brain biopsy revealed extensive macrophage infiltration. Given these results and positive antinuclear antibodies in the blood, immunosuppressive and immunomodulatory treatment was implemented but it was not effective. The patient developed progressive quadriparesis, sleep disturbances, and dementia. Second brain biopsy was performed and it revealed germinoma cells. Chemotherapy was administered, but the girl died due to disseminated intravascular coagulation syndrome. The reported case shows an unusual coexistence of germinoma with prominent inflammation in the brain and highlights the importance of brain biopsy in such complex cases.
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Affiliation(s)
- Katarzyna Pierzchlewicz
- Department of Neurology and Epileptology, Children's Memorial Health Institute, Warsaw, Poland
| | - Małgorzata Bilska
- Department of Neurology and Epileptology, Children's Memorial Health Institute, Warsaw, Poland
| | - Elżbieta Jurkiewicz
- Department of Diagnostic Imaging, Children's Memorial Health Institute, Warsaw, Poland
| | - Dariusz Chmielewski
- Department of Neurology and Epileptology, Children's Memorial Health Institute, Warsaw, Poland
| | - Elżbieta Moszczyńska
- Department of Endocrinology, Children's Memorial Health Institute, Warsaw, Poland
| | - Paweł Daszkiewicz
- Department of Neurosurgery, Children's Memorial Health Institute, Warsaw, Poland
| | - Maciej Ciołkowski
- Department of Neurosurgery, Children's Memorial Health Institute, Warsaw, Poland
| | - Wiesława Grajkowska
- Department of Pathology, Children's Memorial Health Institute, Warsaw, Poland
| | - Katarzyna Kotulska
- Department of Neurology and Epileptology, Children's Memorial Health Institute, Warsaw, Poland
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Abstract
Hypophysitis is the acute or chronic inflammation of the pituitary gland. The spectrum of hypophysitis has expanded in recent years with the addition of two histologic subtypes and recognition as a complication of treatment with immune checkpoint inhibitors. Despite the increased number of published cases, the pathogenesis of hypophysitis is poorly understood, and treatment strategies are diverse and controversial. The diagnosis of hypophysitis generally requires histopathologic confirmation. The presentation and clinical course of hypophysitis varies. Hypophysitis can resolve spontaneously, relapse may occur, and some cases can be refractory to treatment.
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Affiliation(s)
- Alexander Faje
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA 02114 USA
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Akiyama Y, Suzuki H, Mikuni N. Germinoma Mimicking Tumefactive Demyelinating Disease in Pediatric Patients. Pediatr Neurosurg 2016; 51:149-53. [PMID: 26811911 DOI: 10.1159/000439028] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 07/24/2015] [Indexed: 11/19/2022]
Abstract
Cases of intracranial germinoma with granulomatous reaction are rare, so a pathological diagnosis of this disease is difficult. In this report, we describe the case of a 13-year-old boy with a bilateral thalamic germinoma which initially mimicked tumefactive demyelinating disease with inflammation, based on the clinical symptoms, imaging results and histology of a biopsy specimen obtained endoscopically. Upon examination of the cerebrospinal fluid, oligoclonal bands were detected. Although his symptoms and radiological findings improved following steroid pulse treatment, they worsened dramatically almost 1 year after the first surgery and even after an additional steroid pulse treatment. Prompted by the clinical course, a second biopsy was performed, and a pathological examination of the specimen showed a two-cell pattern. The diagnosis was changed to intracranial germinoma. After chemotherapeutic treatment with etoposide and cisplatin, the patient's symptoms and radiological findings dramatically improved. We conclude that it is very challenging to distinguish germinomas with a granulomatous reaction due to other inflammatory diseases, especially when only small specimens can be obtained. Stereotactic or endoscopic biopsies should be performed using samples from several different points even if the lesions are associated with eloquent brain regions.
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Affiliation(s)
- Yukinori Akiyama
- Department of Neurosurgery, Sapporo Medical University School of Medicine, Sapporo, Japan
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