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Takezoe T, Watanabe T, Ogawa K, Tomonaga K, Nomura M, Ohno M, Tahara K, Hishiki T, Fujino A, Ishimaru T, Kanamori Y. Primary thymic germinoma in an 11-year-old male with Lowe syndrome. Pediatr Blood Cancer 2024; 71:e30962. [PMID: 38532276 DOI: 10.1002/pbc.30962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 02/28/2024] [Accepted: 03/05/2024] [Indexed: 03/28/2024]
Affiliation(s)
- Toshiko Takezoe
- Division of Surgery, Department of Surgical Specialties, National Center for Child Health and Development, Tokyo, Japan
| | - Toshihiko Watanabe
- Division of Surgery, Department of Surgical Specialties, National Center for Child Health and Development, Tokyo, Japan
| | - Katsuhiro Ogawa
- Division of Surgery, Department of Surgical Specialties, National Center for Child Health and Development, Tokyo, Japan
| | - Kotaro Tomonaga
- Division of Surgery, Department of Surgical Specialties, National Center for Child Health and Development, Tokyo, Japan
| | - Mioko Nomura
- Division of Surgery, Department of Surgical Specialties, National Center for Child Health and Development, Tokyo, Japan
| | - Michinobu Ohno
- Division of Surgery, Department of Surgical Specialties, National Center for Child Health and Development, Tokyo, Japan
| | - Kazunori Tahara
- Division of Surgery, Department of Surgical Specialties, National Center for Child Health and Development, Tokyo, Japan
| | - Tomoro Hishiki
- Division of Surgery, Department of Surgical Specialties, National Center for Child Health and Development, Tokyo, Japan
| | - Akihiro Fujino
- Division of Surgery, Department of Surgical Specialties, National Center for Child Health and Development, Tokyo, Japan
| | - Tetsuya Ishimaru
- Division of Surgery, Department of Surgical Specialties, National Center for Child Health and Development, Tokyo, Japan
| | - Yutaka Kanamori
- Division of Surgery, Department of Surgical Specialties, National Center for Child Health and Development, Tokyo, Japan
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Fujisawa H, Takeuchi T, Ishii A, Muto J, Kamasaki H, Suzuki A, Sugimura Y. Absence of anti-rabphilin-3A antibodies in children and young adults with idiopathic central diabetes insipidus: a potential clue to elucidating a tumor etiology. Hormones (Athens) 2023; 22:747-758. [PMID: 37697216 PMCID: PMC10651553 DOI: 10.1007/s42000-023-00484-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 08/31/2023] [Indexed: 09/13/2023]
Abstract
BACKGROUND Central diabetes insipidus (CDI) is a rare condition caused by various underlying diseases, including neoplasms, autoimmune diseases, and infiltrative diseases. Differentiating between CDI etiologies is difficult. What has initially been classified as "idiopathic" central diabetes insipidus might in fact underlie various pathogenic mechanisms that are less understood to date and/or are not obvious at initial presentation. Therefore, even if idiopathic CDI is diagnosed at the time of onset, it is common for tumors such as germinoma to develop during surveillance. Crucially, a delayed diagnosis of germinoma may be associated with a worse prognosis. Recently, the presence of anti-rabphilin-3A antibodies has been found to be a highly sensitive and specific marker of lymphocytic infundibuloneurohypophysitis, an autoimmune-mediated CDI. CASE PRESENTATION We herein present two cases, namely, a 13-year-old boy (patient 1) and a 19-year-old young man (patient 2) who were diagnosed with idiopathic CDI. In both patients, panhypopituitarism developed. Magnetic resonance imaging revealed pituitary stalk thickening and pituitary swelling approximately 1 1/2 years after the onset of CDI. Western blotting did not reveal the presence of anti-rabphilin-3A antibodies in serum in either patient, suggesting that autoimmune mechanisms might not be involved. Both patients were subsequently diagnosed with germinoma on pathological examination. They received chemotherapy, followed by radiation therapy. Notably, testosterone and insulin-like growth factor-1 levels normalized, and libido and beard growth recovered after chemoradiotherapy in patient 2. CONCLUSION Our data suggest that the absence of anti-rabphilin-3A antibodies in young patients clinically diagnosed with idiopathic CDI may increase the probability of the development of non-lymphocytic lesions, including germinoma. We thus recommend a more attentive approach at the onset of these diseases.
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Affiliation(s)
- Haruki Fujisawa
- Department of Endocrinology, Diabetes and Metabolism, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-Cho, Toyoake, Aichi, 470-1192, Japan
| | - Takako Takeuchi
- Department of Pediatrics, Sapporo Medical University School of Medicine, Sapporo, 060-8556, Japan
| | - Akira Ishii
- Department of Pediatrics, Sapporo Medical University School of Medicine, Sapporo, 060-8556, Japan
| | - Jun Muto
- Department of Neurosurgery, Fujita Health University, Toyoake, Aichi, 470-1192, Japan
| | - Hotaka Kamasaki
- Department of Pediatrics, Sapporo Medical University School of Medicine, Sapporo, 060-8556, Japan
| | - Atsushi Suzuki
- Department of Endocrinology, Diabetes and Metabolism, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-Cho, Toyoake, Aichi, 470-1192, Japan
| | - Yoshihisa Sugimura
- Department of Endocrinology, Diabetes and Metabolism, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-Cho, Toyoake, Aichi, 470-1192, Japan.
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Tomita S, Fujiwara M, Yaguchi A, Ishibashi T, Tomita O, Fujimura J, Shimizu Y, Suzuki M, Kondo A, Shimizu T. Germinoma with optic nerve involvement: A rare case of progressive vision loss misdiagnosed as psychogenic vision loss. Pediatr Blood Cancer 2023; 70:e30635. [PMID: 37596910 DOI: 10.1002/pbc.30635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 07/31/2023] [Indexed: 08/21/2023]
Affiliation(s)
- Sayaka Tomita
- Department of Pediatrics, Faculty of Medicine, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - Megumi Fujiwara
- Department of Pediatrics, Faculty of Medicine, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - Akinori Yaguchi
- Department of Pediatrics, Faculty of Medicine, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - Takeshi Ishibashi
- Department of Pediatrics, Faculty of Medicine, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - Osamu Tomita
- Department of Pediatrics, Faculty of Medicine, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - Junya Fujimura
- Department of Pediatrics, Faculty of Medicine, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - Yuzaburo Shimizu
- Department of Neurosurgery, Faculty of Medicine, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - Mario Suzuki
- Department of Neurosurgery, Faculty of Medicine, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - Akihide Kondo
- Department of Neurosurgery, Faculty of Medicine, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - Toshiaki Shimizu
- Department of Pediatrics, Faculty of Medicine, Juntendo University, Bunkyo-ku, Tokyo, Japan
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Thakar S, Mohiuddin MK, Sriramanakoppa NN, Aryan S. Disseminated Intracranial Germinoma Presenting with Wallerian Degeneration. Neurol India 2023; 71:604-605. [PMID: 37322782 DOI: 10.4103/0028-3886.378666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Affiliation(s)
- Sumit Thakar
- Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Whitefield, Bengaluru, Karnataka, India
| | - Muhammad Khizar Mohiuddin
- Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Whitefield, Bengaluru, Karnataka, India
| | - Nayana Nagappa Sriramanakoppa
- Department of Pathology, Sri Sathya Sai Institute of Higher Medical Sciences, Whitefield, Bengaluru, Karnataka, India
| | - Saritha Aryan
- Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Whitefield, Bengaluru, Karnataka, India
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Ju Y, Liu P, Li L, Zhou L, Liu X, He J. Diencephalic syndrome in a female child due to intracranial germinoma: a case report. Childs Nerv Syst 2022; 38:2033-2035. [PMID: 35507081 DOI: 10.1007/s00381-022-05528-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 04/11/2022] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Diencephalic syndrome (DS) is a rare syndrome with failure to thrive (FTT) as the primary manifestation, which is often associated with astrocytoma or glioma and rarely caused by germinoma. To our knowledge, there are no reports of female patients presenting with DS secondary to germinoma. CASE REPORT we report a case (an 11-year-old girl) of diencephalic syndrome presenting with FTT. She was diagnosed with severe malnutrition in the local hospital two years before admission and still did not show normal development after long-term nutritional support. Finally, after ruling out increased metabolism, inadequate caloric intake, and nutrient absorption, intracranial MRI showed a space-occupying lesion in the suprasellar cisterna-hypothalamus area. After excluding other causes of FTT, a biopsy was performed for pathological examination and demonstrated a germinoma. An excellent therapeutic effect was achieved during the three-month follow-up after radiotherapy. CONCLUSION This case reminds us that intracranial tumors should be considered an indispensable etiology for patients with suspicious FTT, and early diagnosis and intervention may achieve a good prognosis.
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Affiliation(s)
- Yan Ju
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, Sichuan, 610041, China.
| | - Peng Liu
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, Sichuan, 610041, China
| | - Li Li
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, Sichuan, 610041, China
| | - Liangxue Zhou
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, Sichuan, 610041, China
| | - Xiaoyin Liu
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, Sichuan, 610041, China
| | - Jiaojiang He
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, Sichuan, 610041, China.
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王 书, 高 阳, 张 宏, 杨 海, 李 辉, 李 宇, 沈 笠, 姚 红. [Clinical analysis of 30 cases of basal ganglia germinoma in children]. Beijing Da Xue Xue Bao Yi Xue Ban 2022; 54:222-226. [PMID: 35435183 PMCID: PMC9069024 DOI: 10.19723/j.issn.1671-167x.2022.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To summarize and analyze the clinical characteristics of children with basal ganglia germinoma and to improve the level of early clinical diagnosis. METHODS The clinical data of children diagnosed with basal ganglia germinoma admitted to the Pediatric Surgery Ward of Peking University First Hospital from January 2013 to December 2020 were retrospectively analyzed, and descriptive statistics were used to analyze the clinical characteristics of children with basal ganglia germinoma. RESULTS A total of 30 patients were included in the study, 28 were male, 2 were female, the mean age at onset was (9.7±2.2) years, the median disease duration was 7 months, 27 had unilateral disease, and 3 had bilateral disease. The clinical manifestations were decreased limb muscle strength, cognitive function disorders, polydipsia, precocious puberty, intracranial hypertension, dysphonia and swallowing dysfunction. The serum and cerebrospinal fluid tumor marker alpha-fetoprotein (AFP) were normal in the 30 patients, and the serum and cerebrospinal fluid tumor marker β-human chorionic gonadotropin (β-HCG) were normal in 8 patients.The serum β-HCG was normal in 11 patients but the cerebrospinal fluid β-HCG was slightly elevated, and the serum and cerebrospinal fluid β-HCG were slightly elevated in 11 patients. A total of 33 lesions with irregular shapes were found by imaging examination, including 15 (45.5%) patchy lesions, 10 (30.3%) patchy lesions, and 8 (24.2%) round-like high-density lesions. Tumors showed obvious high-density shadows on computed tomography (CT) scan. Magnetic resonance imaging (MRI) scan of the tumors showed low or isointensity on T1WI and isointensity on T2WI, accompanied by mild peritumoral edema, hemispheric atrophy, cerebral peduncle atrophy, calcification, cystic degeneration, ventricular dilatation and wallerian degeneration. On contrast-enhanced scans, the tumor showed no enhancement or heterogeneous enhancement. CONCLUSION The main age of onset of germ cell tumors in the basal ganglia in children is about 10 years old, and males are absolutely dominant. The clinical features and imaging manifestations have certain characteristics. With both combined, the early diagnosis of germ cell tumors in the basal ganglia can be improved.
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Affiliation(s)
- 书磊 王
- />北京大学第一医院小儿外科, 北京 100034Department of Pediatric Surgery, Peking University First Hospital, Beijing 100034, China
| | - 阳旭 高
- />北京大学第一医院小儿外科, 北京 100034Department of Pediatric Surgery, Peking University First Hospital, Beijing 100034, China
| | - 宏武 张
- />北京大学第一医院小儿外科, 北京 100034Department of Pediatric Surgery, Peking University First Hospital, Beijing 100034, China
| | - 海波 杨
- />北京大学第一医院小儿外科, 北京 100034Department of Pediatric Surgery, Peking University First Hospital, Beijing 100034, China
| | - 辉 李
- />北京大学第一医院小儿外科, 北京 100034Department of Pediatric Surgery, Peking University First Hospital, Beijing 100034, China
| | - 宇 李
- />北京大学第一医院小儿外科, 北京 100034Department of Pediatric Surgery, Peking University First Hospital, Beijing 100034, China
| | - 笠雪 沈
- />北京大学第一医院小儿外科, 北京 100034Department of Pediatric Surgery, Peking University First Hospital, Beijing 100034, China
| | - 红新 姚
- />北京大学第一医院小儿外科, 北京 100034Department of Pediatric Surgery, Peking University First Hospital, Beijing 100034, China
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Affiliation(s)
| | - Matteo Martinoni
- IRCCS Istituto Delle Scienze Neurologiche di Bologna, Bologna, Italy
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Minter DJ, Richie M, Kumthekar P, Hollander H. Stalking the Diagnosis. N Engl J Med 2021; 384:1262-1267. [PMID: 33789016 DOI: 10.1056/nejmcps2028560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Daniel J Minter
- From the Departments of Medicine (D.J.M., H.H.) and Neurology (M.R.) and the Division of Infectious Diseases (H.H.), University of California, San Francisco, San Francisco; and the Department of Neurology and the Division of Hematology and Oncology, Feinberg School of Medicine, Northwestern University, Chicago (P.K.)
| | - Megan Richie
- From the Departments of Medicine (D.J.M., H.H.) and Neurology (M.R.) and the Division of Infectious Diseases (H.H.), University of California, San Francisco, San Francisco; and the Department of Neurology and the Division of Hematology and Oncology, Feinberg School of Medicine, Northwestern University, Chicago (P.K.)
| | - Priya Kumthekar
- From the Departments of Medicine (D.J.M., H.H.) and Neurology (M.R.) and the Division of Infectious Diseases (H.H.), University of California, San Francisco, San Francisco; and the Department of Neurology and the Division of Hematology and Oncology, Feinberg School of Medicine, Northwestern University, Chicago (P.K.)
| | - Harry Hollander
- From the Departments of Medicine (D.J.M., H.H.) and Neurology (M.R.) and the Division of Infectious Diseases (H.H.), University of California, San Francisco, San Francisco; and the Department of Neurology and the Division of Hematology and Oncology, Feinberg School of Medicine, Northwestern University, Chicago (P.K.)
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Kanamori M, Takami H, Yamaguchi S, Sasayama T, Yoshimoto K, Tominaga T, Inoue A, Ikeda N, Kambe A, Kumabe T, Matsuda M, Tanaka S, Natsumeda M, Matsuda KI, Nonaka M, Kurihara J, Yamaoka M, Kagawa N, Shinojima N, Negoto T, Nakahara Y, Arakawa Y, Hatazaki S, Shimizu H, Yoshino A, Abe H, Akimoto J, Kawanishi Y, Suzuki T, Natsume A, Nagane M, Akiyama Y, Keino D, Fukami T, Tomita T, Kanaya K, Tokuyama T, Izumoto S, Nakada M, Kuga D, Yamamoto S, Anei R, Uzuka T, Fukai J, Kijima N, Terashima K, Ichimura K, Nishikawa R. So-called bifocal tumors with diabetes insipidus and negative tumor markers: are they all germinoma? Neuro Oncol 2021; 23:295-303. [PMID: 32818237 PMCID: PMC7906060 DOI: 10.1093/neuonc/noaa199] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The Delphi consensus statements on the management of germ cell tumors (GCTs) failed to reach agreements on the statement that the cases with (i) pineal and neurohypophyseal bifocal lesion, (ii) with diabetes insipidus, and (iii) with negative tumor markers can be diagnosed as germinoma without histological verification. To answer this, multicenter retrospective analysis was performed. METHODS A questionnaire on clinical findings, histological diagnosis, and details of surgical procedures was sent to 86 neurosurgical and 35 pediatrics departments in Japan. RESULTS Fifty-one institutes reported 132 cases that fulfilled the 3 criteria. Tissue sampling was performed in 91 cases from pineal (n = 44), neurohypophyseal (n = 32), both (n = 6), and distant (n = 9) lesions. Histological diagnosis was established in 89 cases: pure germinoma or germinoma with syncytiotrophoblastic giant cells in 82 (92.1%) cases, germinoma and mature teratoma in 2 cases, and granulomatous inflammation in 2 cases. Histological diagnosis was not established in 2 cases. Although no tumors other than GCTs were identified, 3 (3.4%) patients had non-germinomatous GCTs (NGGCTs). None of the patients developed permanent complications after endoscopic or stereotactic biopsy. Thirty-nine patients underwent simultaneous procedure for acute hydrocephalus without permanent complications, and hydrocephalus was controlled in 94.9% of them. CONCLUSION All patients who fulfilled the 3 criteria had GCTs or granulomatous inflammation, but not other types of tumors. However, no fewer than 3.4% of the patients had NGGCTs. Considering the safety and the effects of simultaneous procedures for acute hydrocephalus, biopsy was recommended in such patients.
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Affiliation(s)
- Masayuki Kanamori
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hirokazu Takami
- Division of Brain Tumor Translational Research, National Cancer Center Research Institute, Tokyo, Japan
- Department of Neurosurgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Shigeru Yamaguchi
- Department of Neurosurgery, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Takashi Sasayama
- Department of Neurosurgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Koji Yoshimoto
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Teiji Tominaga
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Akihiro Inoue
- Department of Neurosurgery, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Naokado Ikeda
- Department of Neurosurgery and Neuroendovascular Surgery, Osaka Medical College, Osaka, Japan
| | - Atsushi Kambe
- Division of Neurosurgery, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Tottori, Japan
| | - Toshihiro Kumabe
- Department of Neurosurgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Masahide Matsuda
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Shota Tanaka
- Department of Neurosurgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Manabu Natsumeda
- Department of Neurosurgery, Brain Research Institute, Niigata University, Niigata, Japan
| | - Ken-Ichiro Matsuda
- Department of Neurosurgery, Faculty of Medicine, Yamagata University, Yamagata, Japan
| | - Masahiro Nonaka
- Department of Neurosurgery, Kansai Medical University, Osaka, Japan
| | - Jun Kurihara
- Department of Neurosurgery, Saitama Children’s Medical Center, Saitama, Japan
| | - Masayoshi Yamaoka
- Department of Pediatrics, The Jikei University School of Medicine, Tokyo, Japan
| | - Naoki Kagawa
- Department of Neurosurgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Naoki Shinojima
- Department of Neurosurgery, Kumamoto University Hospital, Kumamoto, Japan
| | - Tetsuya Negoto
- Department of Neurosurgery, Kurume University School of Medicine, Kurume, Japan
| | - Yukiko Nakahara
- Department of Neurosurgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Yoshiki Arakawa
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Seiji Hatazaki
- Department of Neurosurgery, Mie University Graduate School of Medicine, Mie, Japan
| | - Hiroaki Shimizu
- Department of Neurosurgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Atsuo Yoshino
- Department of Neurological Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Hiroshi Abe
- Department of Neurosurgery, Fukuoka University, Fukuoka, Japan
| | - Jiro Akimoto
- Department of Neurosurgery, Tokyo Medical University, Tokyo, Japan
| | - Yu Kawanishi
- Department of Neurosurgery, Kochi Medical School, Kochi University, Nankoku, Japan
| | - Tomonari Suzuki
- Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, Saitama, Japan
| | - Atsushi Natsume
- Department of Neurosurgery, Nagoya University School of Medicine, Nagoya, Japan
| | - Motoo Nagane
- Department of Neurosurgery, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Yukinori Akiyama
- Department of Neurosurgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Dai Keino
- Division of Hematology/Oncology, Kanagawa Children`s Medical Center, Yokohama, Japan
| | - Tadateru Fukami
- Department of Neurosurgery, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Takahiro Tomita
- Department of Neurosurgery, University of Toyama, Toyama, Japan
| | - Kohei Kanaya
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Tsutomu Tokuyama
- Department of Neurosurgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Shuichi Izumoto
- Department of Neurosurgery, Kindai University Faculty of Medicine, Sayama, Japan
| | - Mitsutoshi Nakada
- Department of Neurosurgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
| | - Daisuke Kuga
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shohei Yamamoto
- Department of Pediatrics, Showa University Fujigaoka Hospital, Kanagawa, Japan
| | - Ryogo Anei
- Department of Neurosurgery, Asahikawa Medical University, Asahikawa, Japan
| | - Takeo Uzuka
- Department of Neurosurgery, Dokkyo Medical University, Tochigi, Japan
| | - Junya Fukai
- Department of Neurological Surgery, Wakayama Medical University School of Medicine Wakayama, Japan
| | - Noriyuki Kijima
- Department of Neurosurgery, Osaka National Hospital, Osaka, Japan
| | - Keita Terashima
- Division of Neuro-Oncology, National Center for Child Health and Development, Tokyo, Japan
| | - Koichi Ichimura
- Division of Brain Tumor Translational Research, National Cancer Center Research Institute, Tokyo, Japan
| | - Ryo Nishikawa
- Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, Saitama, Japan
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Tian J, Wu J, Yan Z, Huang H. Intracranial Germinoma Misdiagnosed as Hyperthyroidism: A Case Report and Review of the Literature. Front Endocrinol (Lausanne) 2021; 12:789109. [PMID: 35140682 PMCID: PMC8818707 DOI: 10.3389/fendo.2021.789109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 12/24/2021] [Indexed: 11/17/2022] Open
Abstract
Intracranial germ cell tumors (GCTs) are relatively rare, which account for 0.5% of all primary intracranial neoplasms. Intracranial germinomas most commonly occur in the pineal and suprasellar region, making up the majority of all intracranial GCTs. For its diversified clinical manifestations, the diagnosis is easily confused with other diseases. Here, we present a case of a 19-year-old boy with intracranial germinoma who was preliminarily misdiagnosed as hyperthyroidism for the symptoms of weight loss and thyroid dysfunction.
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Devuyst F, Kazakou P, Balériaux D, Alexopoulou O, Burniat A, Salenave S, Chanson P, Corvilain B, Maiter D. Central diabetes insipidus and pituitary stalk thickening in adults: distinction of neoplastic from non-neoplastic lesions. Eur J Endocrinol 2020; 181:95-105. [PMID: 32530258 DOI: 10.1530/eje-20-0058] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
CONTEXT Association of central diabetes insipidus (CDI) and pituitary stalk thickening (PST) may have several etiologies (including malignancies) and differential diagnosis remains often difficult. OBJECTIVE The purpose of this study was to identify which clinical, biochemical or radiological features could help clinicians to make an etiological diagnosis, especially distinguishing neoplastic from non-neoplastic pituitary stalk lesions. DESIGNS AND METHODS We retrospectively analyzed clinical, biochemical, radiological and histological data of 38 adult patients diagnosed with CDI and PST of proven etiology. RESULTS Of the 38 pituitary stalk lesions included, 11 (29%) were neoplastic. A histopathological diagnosis was obtained in 22/38 (58%) patients. The three most frequently observed etiologies of PST were neuroinfundibulitis (34%), germinoma (21%) and histiocytosis (18%). Pituitary stalk thickness was larger for neoplastic lesions, particularly germinomas. Male gender and a very young age were statistically associated with a risk of germinoma. At least one anterior pituitary deficit was observed in nearly 60% of patients. Patients with neoplastic PST were more affected by multiple anterior pituitary dysfunction than patients with benign PST. A high serum prolactin level was individually the best predictor of a neoplastic origin (90% sensitivity and 60% specificity for a serum prolactin level 1.27-fold above the normal upper limit (ULN)). CONCLUSION We confirm a relatively high risk of malignancy in adult patients presenting with the association of CDI and PST. Young age, male gender, a very large thickening of the stalk, multiple anterior pituitary deficits and prolactin above 1.3× ULN increase the likelihood of a neoplastic origin.
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Affiliation(s)
- France Devuyst
- Department of Endocrinology, Erasme Hospital, Université libre de Bruxelles, Brussels, Belgium
| | - Paraskevi Kazakou
- Endocrine Unit, Department of Medical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Danielle Balériaux
- Department of Neuroradiology, Erasme Hospital, Université libre de Bruxelles, Brussels, Belgium
| | - Orsalia Alexopoulou
- Department of Endocrinology and Nutrition, Université Catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Agnès Burniat
- Department of Endocrinology, Erasme Hospital, Université libre de Bruxelles, Brussels, Belgium
| | - Sylvie Salenave
- Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, Centre de Référence des Maladies Rares de l'Hypophyse, Le Kremlin Bicêtre, France
| | - Philippe Chanson
- Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, Centre de Référence des Maladies Rares de l'Hypophyse, Le Kremlin Bicêtre, France
- Université Paris-Saclay, Univ. Paris-Sud, Inserm, Signalisation Hormonale, Physiopathologie Endocrinienne et Métabolique, Le Kremlin-Bicêtre, France
| | - Bernard Corvilain
- Department of Endocrinology, Erasme Hospital, Université libre de Bruxelles, Brussels, Belgium
| | - Dominique Maiter
- Department of Endocrinology and Nutrition, Université Catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium
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12
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Celik O, Ozyurt S, Saglican Y. Suprasellar germinoma with hypopituitarism in an 18-year old man: A case report and review of literature. Clin Neurol Neurosurg 2020; 196:106026. [PMID: 32580069 DOI: 10.1016/j.clineuro.2020.106026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 05/20/2020] [Accepted: 06/14/2020] [Indexed: 11/30/2022]
Abstract
An 18 year old patient was presented to the ophtalmology outpatient clinic with blurrred vision, headache and fatigue for 6 months. Ophtalmological examination showed loss of visual acuity in the left eye and decreased in the right eye and bilateral optic atrophy. Further physical examination pointed out delayed sexual development. Hypopituitarism was observed in endocrinological examination. Brain magnetic resonance imaging (MRI) demonstrated contrast enhancing mass lesion at suprasellar region with involvement of posterior perimesencephalic cisternal region. The mass resected by craniotomy and pathology showed germinoma. Afterwards he received systemic chemotherapy with bleomisin, etoposide, cisplatin for 4 cycles followed by cranial radiotherapy with 30.6 Gy with a boost to the primary tumor at a dose of 19.8 Gy. On his follow-up MRI, there are no signs of residual tumor nor tumor recurrence. His final examination reveals slightly increased visual acuity in the right eye and he continued to take hydrocortisone and L-thyroxin. After one year follow-up, human chorionic gonadotropin (hCG) alpha treatment was started for sexual development. Here in, we present a case with suprasellar germinoma in the context of the review of the literature.
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Affiliation(s)
- Ozlem Celik
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Acibadem Medical School, University of Acibadem, Istanbul, Turkey.
| | - Semih Ozyurt
- Department of Internal Medicine, Acibadem Medical School, University of Acibadem, Istanbul, Turkey
| | - Yesim Saglican
- Department of Pathology, Acibadem Medical School, University of Acibadem, Istanbul, Turkey
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13
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Abstract
The association between Down syndrome and testicular germ cell tumors may be more frequent than expected according to chance, but few reports have focused on this excess. We report two cases of this association and review the English medical literature.
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Affiliation(s)
- M J Villanueva
- Medical Oncology Service, University Hospital Clínica Puerta De Hierro, Madrid, Spain.
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14
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Chua FHZ, Low DCY, Lian DWQ, Tew SW, Low SYY. Anomalous intracranial germinoma with unilateral cerebral peduncle swelling. Childs Nerv Syst 2017; 33:563-565. [PMID: 28283777 DOI: 10.1007/s00381-017-3355-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Accepted: 01/30/2017] [Indexed: 11/26/2022]
Affiliation(s)
- Felicia H Z Chua
- Neurosurgical Service, KK Women's and Children's Hospital (Singapore), 100 Bukit Timah Road, Singapore, 229899, Singapore
| | - David C Y Low
- Neurosurgical Service, KK Women's and Children's Hospital (Singapore), 100 Bukit Timah Road, Singapore, 229899, Singapore
- Department of Neurosurgery, National Neuroscience Institute (Singapore), 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore
- SingHealth Duke-NUS Neuroscience Academic Clinical Program, Singapore, Singapore
| | - Derrick W Q Lian
- Department of Pathology & Laboratory Medicine, KK Women's and Children's Hospital (Singapore), 100 Bukit Timah Road, Singapore, 229899, Singapore
| | - Seow Wan Tew
- Neurosurgical Service, KK Women's and Children's Hospital (Singapore), 100 Bukit Timah Road, Singapore, 229899, Singapore
- Department of Neurosurgery, National Neuroscience Institute (Singapore), 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore
- SingHealth Duke-NUS Neuroscience Academic Clinical Program, Singapore, Singapore
| | - Sharon Y Y Low
- Neurosurgical Service, KK Women's and Children's Hospital (Singapore), 100 Bukit Timah Road, Singapore, 229899, Singapore.
- Department of Neurosurgery, National Neuroscience Institute (Singapore), 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore.
- SingHealth Duke-NUS Neuroscience Academic Clinical Program, Singapore, Singapore.
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15
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MacDonald SM, Rapalino O, Sherry NA, Cohen AB, Ebb DH, Tarbell NJ, Oakley DH. Case 32-2016. A 20-Year-Old Man with Gynecomastia. N Engl J Med 2016; 375:1567-1579. [PMID: 27797319 DOI: 10.1056/nejmcpc1610098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Shannon M MacDonald
- From the Departments of Radiation Oncology (S.M.M., N.J.T.), Radiology (O.R.), Pediatric Endocrinology (N.A.S.), Neurology (A.B.C.), Pediatric Hematology-Oncology (D.H.E.), and Pathology (D.H.O.), Massachusetts General Hospital, and the Departments of Radiation Oncology (S.M.M., N.J.T.), Radiology (O.R.), Pediatric Endocrinology (N.A.S.), Neurology (A.B.C.), Pediatric Hematology-Oncology (D.H.E.), and Pathology (D.H.O.), Harvard Medical School - both in Boston
| | - Otto Rapalino
- From the Departments of Radiation Oncology (S.M.M., N.J.T.), Radiology (O.R.), Pediatric Endocrinology (N.A.S.), Neurology (A.B.C.), Pediatric Hematology-Oncology (D.H.E.), and Pathology (D.H.O.), Massachusetts General Hospital, and the Departments of Radiation Oncology (S.M.M., N.J.T.), Radiology (O.R.), Pediatric Endocrinology (N.A.S.), Neurology (A.B.C.), Pediatric Hematology-Oncology (D.H.E.), and Pathology (D.H.O.), Harvard Medical School - both in Boston
| | - Nicole A Sherry
- From the Departments of Radiation Oncology (S.M.M., N.J.T.), Radiology (O.R.), Pediatric Endocrinology (N.A.S.), Neurology (A.B.C.), Pediatric Hematology-Oncology (D.H.E.), and Pathology (D.H.O.), Massachusetts General Hospital, and the Departments of Radiation Oncology (S.M.M., N.J.T.), Radiology (O.R.), Pediatric Endocrinology (N.A.S.), Neurology (A.B.C.), Pediatric Hematology-Oncology (D.H.E.), and Pathology (D.H.O.), Harvard Medical School - both in Boston
| | - Adam B Cohen
- From the Departments of Radiation Oncology (S.M.M., N.J.T.), Radiology (O.R.), Pediatric Endocrinology (N.A.S.), Neurology (A.B.C.), Pediatric Hematology-Oncology (D.H.E.), and Pathology (D.H.O.), Massachusetts General Hospital, and the Departments of Radiation Oncology (S.M.M., N.J.T.), Radiology (O.R.), Pediatric Endocrinology (N.A.S.), Neurology (A.B.C.), Pediatric Hematology-Oncology (D.H.E.), and Pathology (D.H.O.), Harvard Medical School - both in Boston
| | - David H Ebb
- From the Departments of Radiation Oncology (S.M.M., N.J.T.), Radiology (O.R.), Pediatric Endocrinology (N.A.S.), Neurology (A.B.C.), Pediatric Hematology-Oncology (D.H.E.), and Pathology (D.H.O.), Massachusetts General Hospital, and the Departments of Radiation Oncology (S.M.M., N.J.T.), Radiology (O.R.), Pediatric Endocrinology (N.A.S.), Neurology (A.B.C.), Pediatric Hematology-Oncology (D.H.E.), and Pathology (D.H.O.), Harvard Medical School - both in Boston
| | - Nancy J Tarbell
- From the Departments of Radiation Oncology (S.M.M., N.J.T.), Radiology (O.R.), Pediatric Endocrinology (N.A.S.), Neurology (A.B.C.), Pediatric Hematology-Oncology (D.H.E.), and Pathology (D.H.O.), Massachusetts General Hospital, and the Departments of Radiation Oncology (S.M.M., N.J.T.), Radiology (O.R.), Pediatric Endocrinology (N.A.S.), Neurology (A.B.C.), Pediatric Hematology-Oncology (D.H.E.), and Pathology (D.H.O.), Harvard Medical School - both in Boston
| | - Derek H Oakley
- From the Departments of Radiation Oncology (S.M.M., N.J.T.), Radiology (O.R.), Pediatric Endocrinology (N.A.S.), Neurology (A.B.C.), Pediatric Hematology-Oncology (D.H.E.), and Pathology (D.H.O.), Massachusetts General Hospital, and the Departments of Radiation Oncology (S.M.M., N.J.T.), Radiology (O.R.), Pediatric Endocrinology (N.A.S.), Neurology (A.B.C.), Pediatric Hematology-Oncology (D.H.E.), and Pathology (D.H.O.), Harvard Medical School - both in Boston
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16
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Nikitović M, Grujičić D, Skender Gazibara M, Stanić D, Bokun J, Sarić M. Intramedullary Spinal Cord Germinoma: A Case Report and Review of Literature. World Neurosurg 2016; 95:392-398. [PMID: 27554307 DOI: 10.1016/j.wneu.2016.08.039] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 08/08/2016] [Accepted: 08/09/2016] [Indexed: 11/19/2022]
Abstract
Primary spinal cord germinomas are an extremely rare group of tumors, most commonly reported as single cases in young Japanese adults. They usually present as intramedullary lesions located in the thoracic and thoracolumbar spine. The importance of preoperative diagnosis lies in the fact that by using radiotherapy and chemotherapy, even without surgery, a good cure rate can be achieved in patients with spinal cord germinoma. These tumors, however, demonstrate unspecific imaging characteristics, and only some secrete tumor markers. Therefore, a diagnosis of these lesions before biopsy or resection with pathohistologic examination can be difficult. We present a case of a 28-year-old white man with intramedullary spinal cord germinoma. The tumor was resected completely with electrophysiological monitoring, without a biopsy and frozen section analysis. Postoperative radiotherapy also was part of the treatment. The patient has had no relapse 4.5 years after diagnosis; however, significant neurologic deficits remain. Although not as frequent in white patients, germinoma should be considered as differential diagnosis in cases of young adult patients with intramedullary tumor in the thoracic or thoracolumbar spine. Therefore, spinal mass surgery should commence with a biopsy and intraoperative frozen section analysis. In this way, attempting a gross total resection becomes unnecessary. With an approach of intraoperative biopsy and frozen section analysis, a considerable amount of postoperative neurologic deficits can be reduced.
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Affiliation(s)
- Marina Nikitović
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia; Institute for Oncology and Radiology of Serbia, Clinic for Radiation Oncology, Belgrade, Serbia.
| | - Danica Grujičić
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia; Clinic of Neurosurgery, Clinical Centre of Serbia, Belgrade, Serbia
| | - Milica Skender Gazibara
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia; Institute of Pathology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Dragana Stanić
- Institute for Oncology and Radiology of Serbia, Clinic for Radiation Oncology, Belgrade, Serbia
| | - Jelena Bokun
- Institute for Oncology and Radiology of Serbia, Clinic for Radiation Oncology, Belgrade, Serbia
| | - Milan Sarić
- Institute for Oncology and Radiology of Serbia, Clinic for Radiation Oncology, Belgrade, Serbia
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17
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Burgueño-Montañés C, Santalla-Castro C, Peña-Suárez J. Parinaud «plus» syndrome in a patient with dysgerminoma. ACTA ACUST UNITED AC 2016; 91:341-5. [PMID: 26900044 DOI: 10.1016/j.oftal.2016.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 01/05/2016] [Accepted: 01/11/2016] [Indexed: 11/30/2022]
Abstract
CLINICAL CASE A 33-year-old male diagnosed with Parinaud's syndrome, exotropia and post-papillary oedema optic atrophy in his left eye. A pineal germinoma was diagnosed after performing neuroimaging scans and a stereotactic biopsy. He was treated with chemotherapy and radiotherapy, showing a complete pathological response. The Parinaud's syndrome persists one year after diagnosis and the patient has refused to have strabismus surgery. DISCUSSION Parinaud's syndrome consists of a supranuclear vertical gaze palsy resulting from damage to the midbrain tectum. The involvement of adjacent structures leads to the «Parinaud-plus» syndrome. When a Parinaud's syndrome is accompanied by diplopia («Parinaud-plus» syndrome), extension of the injury into adjacent areas must be considered.
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Affiliation(s)
- C Burgueño-Montañés
- Servicio de Oftalmología, Hospital Universitario Central de Asturias, Oviedo, Asturias, España.
| | - C Santalla-Castro
- Servicio de Oftalmología, Hospital Universitario Central de Asturias, Oviedo, Asturias, España
| | - J Peña-Suárez
- Servicio de Radiodiagnóstico, Hospital Universitario Central de Asturias, Oviedo, Asturias, España
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18
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Taramasso L, Boisson-Dupuis S, Garrè ML, Bondi E, Cama A, Nozza P, Morana G, Casanova JL, Marazzi MG. Pineal germinoma in a child with interferon-γ receptor 1 deficiency. case report and literature review. J Clin Immunol 2014; 34:922-7. [PMID: 25216720 DOI: 10.1007/s10875-014-0098-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 09/02/2014] [Indexed: 12/19/2022]
Abstract
Interferon-γ receptor 1 (IFN-γR1) deficiency is one of the primary immunodeficiencies conferring Mendelian Susceptibility to Mycobacterial Disease (MSMD). Some cases of neoplasms have been recently reported in patients with MSMD, underlying the already known link between immunodeficiency and carcinogenesis. We report the first case of intracranial tumour, i.e. pineal germinoma, in a 11-year-old patient with complete IFN-γR1 deficiency. The first clinical presentation of the genetic immunodeficiency dates back to when the child was aged 2 y and 10 mo, when he presented a multi-focal osteomyelitis caused by Mycobacterium scrofulaceum. The diagnosis of IFN-γR1 deficiency (523delT/523delT in IFNGR1 gene) was subsequently made. The child responded to antibiotic therapy and remained in stable clinical condition until the age of 11 years, when he started complaining of frontal, chronic headache. MRI revealed a solid pineal region mass lesion measuring 20 × 29 × 36 mm. Histological findings revealed a diagnosis of pineal germinoma. The patient received chemotherapy followed by local whole ventricular irradiation with boost on pineal site, experiencing complete remission, and to date he is tumor-free at four years follow-up. Four other cases of tumors have been reported in patients affected by MSMD in our knowledge: a case of Kaposi sarcoma, a case of B-cell lymphoma, a case of cutaneous squamous cell carcinoma and a case of oesophageal squamous cell carcinoma. In conclusion, in patients with MSMD, not only the surveillance of infectious diseases, but also that of tumors is important.
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Affiliation(s)
- L Taramasso
- Infectious Disease Department, San Martino Hospital, University of Genova, 16100, Genoa, Italy,
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19
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Satoh S, Goto H, Izaki K, Sakuma H, Watanabe K. [Intracranial germinoma associated with Down syndrome: case report and review of literature]. No Shinkei Geka 2012; 40:137-143. [PMID: 22281466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
It is well known that Down syndrome is sometimes associated with leukemia. However, there have been only a few case reports of a relationship between Down syndrome and brain tumors. The case was that of a 35-year-old man with Down syndrome complaining of gait disturbance. Computed tomography (CT) and magnetic resonance imaging (MRI) showed a mass lesion in the pineal and bilateral cerebello-pontine cistern and spinal cord, marked hydrocephalus. Endoscopic biopsy and third ventriculostomy was performed. Surgical specimens showed typical germinoma. The patient was treated with a combination of chemotherapy with carboplatin and etposide, and irradiation. However he finally died 35 months after these therapies. Cases of malignant tumors other than leukemia, which are associated with Down syndrome, are extremely rare. We reviewed such rare cases of Down syndrome and intracranial germ cell tumor.
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Affiliation(s)
- Shunsuke Satoh
- Department of Neurosurgery, Southern TOHOKU Research Institute for Neuroscience, Japan
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20
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Gutenberg A, Bell JJ, Lupi I, Tzou SC, Landek-Salgado MA, Kimura H, Su J, Karaviti LP, Salvatori R, Caturegli P. Pituitary and systemic autoimmunity in a case of intrasellar germinoma. Pituitary 2011; 14:388-94. [PMID: 19466616 PMCID: PMC3291822 DOI: 10.1007/s11102-009-0187-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2009] [Accepted: 05/10/2009] [Indexed: 11/26/2022]
Abstract
Germinomas arising in the sella turcica are difficult to differentiate from autoimmune hypophysitis because of similar clinical and pathological features. This differentiation, nevertheless, is critical for patient care due to different treatments of the two diseases. We report the case of an 11-year-old girl who presented with diabetes insipidus and growth retardation, and was found to have an intra- and supra-sellar mass. Initial examination of the pituitary biopsy showed diffuse lymphocytic infiltration of the adenohypophysis and absent placental alkaline phosphatase expression, leading to a diagnosis of hypophysitis and glucocorticoid treatment. Because of the lack of clinical and radiological response, the pituitary specimen was re-examined, revealing this time the presence of scattered c-kit and Oct4 positive germinoma cells. The revised diagnosis prompted the initiation of radiotherapy, which induced disappearance of the pituitary mass. Immunological studies showed that the patient's serum recognized antigens expressed by the patient's own germinoma cells, as well as pituitary antigens like growth hormone and systemic antigens like the Sjögren syndrome antigen B and alpha-enolase. The study first reports the presence of pituitary and systemic antibodies in a patient with intrasellar germinoma, and reminds us that diffuse lymphocytic infiltration of the pituitary gland and pituitary antibodies does not always indicate a diagnosis of autoimmune hypophysitis.
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Affiliation(s)
- Angelika Gutenberg
- Department for Neurosurgery, Georg August University Göttingen, Göttingen, Germany
| | - Jennifer J. Bell
- Department for Pediatrics, Texas Children’s Hospital, Houston, TX USA
| | - Isabella Lupi
- Department of Endocrinology, University of Pisa, Pisa, Italy
| | - Shey-Cherng Tzou
- Department for Pathology, Johns Hopkins University, Baltimore, MD USA
| | | | - Hiroaki Kimura
- Department for Pathology, Johns Hopkins University, Baltimore, MD USA
| | - Jack Su
- Department for Pediatrics, Texas Children’s Hospital, Houston, TX USA
| | | | - Roberto Salvatori
- Division of Endocrinology, Department of Medicine, Johns Hopkins University, Baltimore, MD USA
| | - Patrizio Caturegli
- Department for Pathology, Johns Hopkins University, Baltimore, MD USA
- Feinstone Department of Molecular Microbiology and Immunology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
- Department for Pathology, Johns Hopkins University, Ross Building, Room 632, 720 Rutland Avenue, Baltimore, MD 21205 USA
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Takezaki S, Okura Y, Ichikawa M, Suzuki D, Ohshima J, Kaneda M, Cho Y, Yamada M, Kawamura N, Iguchi A, Kobayashi I, Ariga T. Development of germinoma during the treatment of systemic-onset juvenile idiopathic arthritis with infliximab. Mod Rheumatol 2011; 22:621-4. [PMID: 22072226 DOI: 10.1007/s10165-011-0555-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2011] [Accepted: 10/24/2011] [Indexed: 11/25/2022]
Abstract
We report a 19-year-old patient with systemic-onset juvenile idiopathic arthritis (JIA) who developed a mediastinal germinoma during treatment with infliximab. Although the cancer risk of infliximab is controversial, this agent may have accelerated the growth of the germinoma. We conclude that the indications for tumor necrosis factor (TNF) inhibitors should be strictly decided and that a nationwide cohort study is necessary to assess the risk of cancer in patients with JIA exposed to biologics.
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Affiliation(s)
- Shunichiro Takezaki
- Department of Pediatrics, Hokkaido University School of Medicine, North-15 West-7, Kita-ku, Sapporo, 060-8638, Japan
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Ji X, Chao X, Fei Z, Zhao Y. Primary frontoparietal lobe convexity germinoma with dural invasion mimics meningioma. Neurosciences (Riyadh) 2011; 16:276-280. [PMID: 21677623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Intracranial germinomas are rare and account for only 0.4-3.4% of primary intracranial tumors. They develop mainly in the midline structures in adolescents. The pineal gland is the most common site of this tumor. Here, we describe an unusual case of a giant primary intracranial germinoma located in the intracranial hemisphere with radiological findings that mimicked a meningioma. The clinical diagnosis of the intracranial germinoma was difficult because of its unusual clinical presentation, the location of the lesion, and atypical imaging findings. Based on this case study, we suggest that germinoma might be a possible diagnosis when a tumor of the hemispheres with dura invasion mimics meningioma, especially in young patients. Furthermore, we recommend that frozen biopsy sections should be taken routinely during surgery to aid in rapid diagnosis and effective therapy.
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Affiliation(s)
- Xituan Ji
- Department of Neurosurgery, Fourth Military Medical University, Xi'an, P. R. China
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23
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Lau CI, Wang HC, Tsai MD, Hsu JL, Hsu WC, Chen JS, Ku CT. Acute Parkinsonian syndrome after ventriculoperitoneal shunt malfunction caused by a roller coaster ride. Clin Neurol Neurosurg 2011; 113:423-5. [PMID: 21320745 DOI: 10.1016/j.clineuro.2010.12.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2010] [Accepted: 12/25/2010] [Indexed: 11/17/2022]
Affiliation(s)
- Chi-Ieong Lau
- Department of Neurology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
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Li YH, Su Z, Ma HM, Chen HS, Gu YF, Du ML. [Diagnostic value of serum levels of β-human chorionic gonadotropin (β-hcG) combined with β-hcG in cerebrospinal fluid for determining locations of germinomas in children with precocious puberty]. Zhonghua Er Ke Za Zhi 2010; 48:771-774. [PMID: 21176488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVE To study the clinical manifestations of germinoma in children with precocious puberty and to evaluate the diagnostic value of serum levels of β-human chorionic gonadotropin (β-hcG) combined with detections of β-hcG in cerebrospinal fluid (CSF). METHOD Twelve male children with germinomas confirmed by pathology from Jan. 2005 to Dec. 2009, aged from 4.2 to 10.2 years, were enrolled in this study. Patients were classified into two groups according to tumor locations: intracranial group and non-intracranial group. Levels of β-hcG in serum as well as in CSF were detected before the initiation of therapy. Age and gender matched 5 children undergoing lumbar puncture for other diseases were set as control group for the determinations of β-hcG in CSF. Levels of β-hcG and testosterone in serum and CSF were compared between intracranial group and non-intracranial group, and levels of β-hcG in CSF were compared between non-intracranial group and control group. RESULT The 12 children showed elevated serum levels of testosterone: 10.43 (1.70-254.00) µg/L, 11 children had testicular volume > 4 ml, while response to LHRH stimulation tests were low; 6 children had gynecomastia. Serum levels of β-hcG were elevated in both intracranial and non-intracranial group and no significant differences were found between groups 63.75 (8.50-309.50) IU/L vs. 59.00 (25.10-71.77) IU/L, P = 0.644. No correlations were found between serum levels of β-hcG and ages, tumor locations, and courses of the patients. Levels of β-hcG in CSF were significantly higher in intracranial group than that in non-intracranial group 488.99 (17.30-1048.53) IU/L vs. 1.20 (1.20-1.50) IU/L, P = 0.009. Children with non-intracranial germinomas had similar levels of β-hcG in CSF as that in control group (P = 0.571). CONCLUSION The main clinical manifestations in boys suffered from germinoma included pseudo-precocious puberty, disproportionate testicular volume and gynecomastia. Detection of serum levels of β-hcG combined with β-hcG levels in CSF may be useful for determination of the locations of germinomas in children with precocious puberty.
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Affiliation(s)
- Yan-hong Li
- Department of Pediatrics, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510080, China
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de Pinho LKJ, Neto LV, Cardão Chimelli LM, Gasparetto EL, Warszawski L, do Souto AAD, Gadelha MR. Germ cell tumor presenting as sellar mass with suprasellar extension and long history of hypopituitarism. Neuro Endocrinol Lett 2010; 31:306-309. [PMID: 20588244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/03/2009] [Accepted: 02/03/2010] [Indexed: 05/29/2023]
Abstract
OBJECTIVE Primary central nervous system germ cell tumors are rare neoplasms usually located in the pineal and/or suprasellar region. Pure germinomas do not usually secrete beta-human chorionic gonadotropin hormone (beta-HCG) or alpha-fetoprotein (AFP) and diagnosis is made a few weeks or months after beginning of symptoms. CASE Here we report a case of a pure germinoma in a 20 year-old woman presenting as a sellar mass with suprasellar extension, abnormal serum beta-HCG and a long history of polyuria and polydipsia (4 years), that was initially diagnosed as a pituitary macroadenoma. CONCLUSION This presentation highlights the importance of thinking in alternative diagnosis to pituitary adenoma when diabetes insipidus is the initial symptom.
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Affiliation(s)
- Leandro Kasuki Jomori de Pinho
- Department of Endocrinology, Hospital Universitário Clementino Fraga Filho, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil.
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Khawam E, Fahed D, Khatib L. Isolated inferior rectus paresis with falling eye phenomenon of the contralateral eye in a patient with pineal tumor: a case report. Binocul Vis Strabismus Q 2010; 25:31-36. [PMID: 20361865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
UNLABELLED PRUPOSE: To report a patient who developed an isolated inferior rectus paresis due to a pineal gland tumor, and to our knowledge never reported before. Our purpose is also to demonstrate that, even in partial and mild inferior rectus muscle paresis, the findings of the inhibitional palsy described by Chavasse and the downshoot of the fellow eye in adduction help determine the diagnosis. CASE REPORT A patient with pineal gland tumor demonstrated findings characteristic of unilateral isolated inferior rectus paresis. CONCLUSION Although bilateral sixth nerve paresis and Parinaud's syndrome are commonly reported in pineal gland tumors; in the the presence of an isolated inferior rectus palsy, one should also consider the pineal gland as the causative factor.
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Affiliation(s)
- Edward Khawam
- Pediatric Ophthalmology and Adult Strabismus, American University of Beirut Medical Center, Lebanon.
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Bakoto N, Strivay M. [Germinoma responsible for central diabetes insipidus]. Rev Med Liege 2009; 64:386-389. [PMID: 19777917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
We report the case of a 20-year-old woman who presented with sudden onset of polydipsia and polyuria. A diagnosis of diabetes insipidus was confirmed and the MRI showed a pituitary stalk enlargement. The patient was treated with Minirin. Two years later, she developed a panhypopituitarism. The MRI showed an intrasellar mass with an enlargement of the pituitary gland. A biopsy confirmed a germinoma. The patient was treated with radiotherapy with a partial response as only a part of the mass disappeared. This case highlights the importance of the clinical and radiological follow-up of central diabetes insipidus, especially when it is of unknown origin. The differential diagnosis will be reviewed.
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Hao S, Liu B, Tang J, Jia G, Zhang Y, Ma Z, Wang Z. Germinoma of basal ganglia in female: case report and review of the literature. Childs Nerv Syst 2009; 25:613-7. [PMID: 19082612 DOI: 10.1007/s00381-008-0769-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2008] [Revised: 08/09/2008] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Germinoma of basal ganglia in female is very rare. The authors present a case of germinoma located in the right temporal lobe and basal ganglia in female and raise a hypothesis for the sex disparity. MATERIALS AND METHODS A 13-year-old Chinese girl complained of weakness in the left extremities and intermittent headache for 2 years. Neuroimaging revealed an irregular lesion in the temple lobe and basal ganglia. A temporal polectomy was performed for the tumor. RESULTS AND DISCUSSION Histopathologic examination confirmed germinoma. The patient remains stable and tumor-free for 36 months after radiotherapy and chemotherapy. The authors' hypothesis is that it is the individual hormone balance which leads to the male predominance of germinoma in the basal ganglia.
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Affiliation(s)
- Shuyu Hao
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, People's Republic of China
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Affiliation(s)
- M A C Mattheij
- Department of Pediatrics, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
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Hieda S, Fukui T. [Germinoma presenting with personality and socio-behavioral abnormalities may challenge differential diagnoses]. Brain Nerve 2008; 60:949-953. [PMID: 18717199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
We described the major diagnostic difficulties encountered in the case of a 25-year-old man with the pathological diagnosis of a germinoma. The patient initially developed an eating disorder at the end of 2003 and a character change ensued since the beginning of 2004. On admission in August 2004, his cardinal symptoms and signs included marked apathy, depersonalization, generalized muscle wasting, and decreased tendon reflexes. Brain T2-weighted (T2-WI) MR and FLAIR images showed high signal intensities in the suprasellar region and at the genu of the corpus callosum that extended along the sub-pia mater of the right anterior horn. These lesions showed mild enhancement on gadolinium-enhanced T1-WI. CSF examination revealed a mildly elevated level of protein and increased cell counts but did not show any malignant cells on repeated spinal tap. The patient's status remained practically unchanged till December 2004 when he developed diabetes insipidus. Soon afterward, the patient collapsed into akinetic mutism and developed corresponding new lesions at the tegmentum of the midbrain. These new lesions disappeared spontaneously and akinetic mutism regressed without any specific therapy. We tentatively diagnosed of neurosarcoidosis based on a characteristic progressive-regressive clinical course, CSF data, and radiological findings. Clinical symptoms and the enhanced masses on MRI were highly responsive to steroid therapy after which the patient was able to return home. However, disturbances in consciousness and tenacious vomiting recurred in September. Brain MRI revealed a markedly re-enlarged and easily enhanced mass at the right anterior horn, which extended into the cerebral aqueduct and resulted in obstructive hydrocephalus. On surgery, histopathological investigation revealed germinoma. This case highlights the need for careful discrimination between a slow growing germinoma and chronic granulomatous diseases of the brain such as neurosarcoidosis. Early histological investigation may be warranted in patients who present difficulties during differential diagnoses.
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Affiliation(s)
- Sotaro Hieda
- Division of Neurology, Department of Internal Medicine, Showa University Northern Yokohama Hospital, Tokyo, Japan
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Zanetta F, Di Dio G, Savastio S, Saccagno A, Petri A, Bellone S, Maghnie M, Bona G. [Germinoma: a rare cerebral tumor causing central diabetes insipidus in childhood]. Minerva Pediatr 2008; 60:129-133. [PMID: 18277371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Germinoma represents 7.8% of cerebral tumors in pediatric age and 50-65% of germ cell cerebral tumors. Generally it is a definite lesion of the pineal gland or suprasellar region, frequently occurring in the first three decades of life. Clinical presentation depends on tumor localization. Pineal lesions generally determine symptoms due to the compression of cerebral structures, causing Parinaud syndrome, while hypothalamic lesions are often characterized by diabetes insipidus, hypopituitarism and visual defects. In the absence of these classic signs and symptoms, however, the diagnosis of germinoma can be difficult. We presented the case of an 8-year-old boy, referred to our clinic for polyuria and polydipsia. Hormonal evaluations demonstrated central diabetes insipidus (CDI), with normal anterior pituitary function. Magnetic resonance imaging (MRI) showed a lack of posterior pituitary gland and partial pituitary stalk enlargement. The patient started therapy with desmopressin (Minirin) with good hydro-electrolytic balance. During follow-up the pituitary function became insufficient with low growth velocity. A second MRI demonstrated a bifocal lesion with dyshomogeneous and cystic appearance, suggesting the diagnosis of germinoma. On the basis of this case report we would like to point out the importance of an early diagnosis in order to improve the prognosis of the disease and the necessity of a careful follow-up of these patients.
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Affiliation(s)
- F Zanetta
- Clinica Pediatrica, Dipartimento di Scienze Mediche, Università del Piemonte Orientale, A. Avogadro, Novara, Italia
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Bednarek-Tupikowska G, Kuliczkowska-Płaksej J, Filus A, Bucyk B, Sokolska V. [A case of hypophyseal and pineal germinoma]. Endokrynol Pol 2007; 58:448-452. [PMID: 18058742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
A case of 19-year-old male with idiopathic diabetes insipidus diagnosed 9 years ago. 1.5 years from the onset of the disease vision disturbances, neurologic deficiencies and symptoms of hypopituitarism showed up. MRI examination revealed an advanced hypophyseal and pineal gland tumor--germinoma. Total regression was achieved with radio- and chemotherapy. For 7 years from the end of treatment patient has not declared any complains except for vision disturbances and hypopituitarism has been substituted successfully. The case puts on the necessity of a strict endocrinologic and radiologic follow-up in patients with idiopathic diabetes insipidus due to the possibility of existing potentially curable disease ie. intracranial tumor.
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Ueba T, Yamashita K, Fujisawa I, Nakao S, Ooyama K, Yorihuji T, Kato SF, Seto S, Kageyama N. Long-term follow-up of 5 patients with intracranial germinoma initially treated by chemotherapy alone. Acta Neurochir (Wien) 2007; 149:897-902; discussion 902. [PMID: 17690837 DOI: 10.1007/s00701-007-1268-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2007] [Accepted: 06/26/2007] [Indexed: 11/26/2022]
Abstract
BACKGROUND High rates of overall- and event-free survival have been reported in patients with intracranial germinoma treated by radiotherapy. We report the long-term results after treatment initially with chemotherapy, but without radiation. PATIENTS AND METHOD Five patients with an intracranial germinoma were treated with 2 cycles of etoposide and cisplatin, without radiotherapy. All achieved complete remission; 3 suffered recurrence within 2 years and were again treated with 2 cycles of etoposide and cisplatin followed by radiotherapy. RESULTS At long-term follow-up, each of the 5 patients was in complete remission without further recurrence. Each patient with a neurohypophyseal germinoma who presented with endocrinopathy had initially recovered endocrinological function. CONCLUSION In a patient with a germinoma chemotherapy, and restriction of radiation to those with recurrence may allow restoration of hypophyseal function damaged by the intracranial germinoma without compromising long term survivial.
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Affiliation(s)
- T Ueba
- Department of Neurosurgery, Kisiwada City Hospital, Osaka, Japan.
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Forooghian F, Chew HF, Muni RH, Adamus G, Drake JM, Buncic JR. Paraneoplastic optic disc oedema and retinal periphlebitis associated with pineal germinoma. Br J Ophthalmol 2007; 91:985-6. [PMID: 17576721 PMCID: PMC1955653 DOI: 10.1136/bjo.2006.112193] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Abstract
OBJECTIVE AND IMPORTANCE We report the extremely rare occurrence of a second germ-cell tumor at a different site and with different histological types long after total resolution of a pineal germinoma. CLINICAL PRESENTATION A 21-year-old man who presented with headache and diplopia was admitted to our hospital. Neuroradiological studies revealed a tumor in the pineal region. The tumor was biopsied with endoscope, and third ventriculostomy was performed. Histologically, the tumor proved to be a germinoma. The patient received 3 cycles of combination chemotherapy consisting of carboplatin and etoposide with radiotherapy. The tumor was totally resolute. Twelve months later, he was readmitted with headache and diplopia. Neuroradiological studies showed a tumor in the right temporal lobe. INTERVENTION The second tumor was totally removed. Histologically, the tumor proved to be a mixed germ-cell tumor, which consisted a yolk-sac tumor and a germinoma. After the second course of chemotherapy, magnetic resonance image studies revealed no evidence of the tumor. CONCLUSION The second tumor was considered to be a metachronous neoplasm rather than a recurrence of the original mixed germ-cell tumor, which consisted a yolk-sac tumor and a germinoma.
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Affiliation(s)
- Kyu-Won Shim
- Department of Neurosurgery, Brain Korea 21 Project for Medical Science, Brain Research Institute, Yonsei University College of Medicine, Seoul, South Korea
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Abstract
Central diabetes insipidus is the end result of a number of different diseases that affect the hypothalamic-neurohypophyseal system. In many patients, especially children and young adults, it is caused by the destruction or degeneration of neurons that originate in the supraoptic and paraventricular nuclei of the hypothalamus. The known causes of these lesions include germinoma or craniopharyngioma; Langerhans cell histiocytosis; local inflammatory, autoimmune or vascular diseases; trauma resulting from surgery or an accident; sarcoidosis; metastases; and midline cerebral and cranial malformations. In rare cases, genetic defects in AVP synthesis that are inherited as autosomal dominant, autosomal recessive or X-linked recessive traits are the underlying cause. Accurate diagnostic differentiation is essential for both safe and effective disease management. Proper etiological diagnosis can be achieved via a series of steps that start with clinical observations and then progress, as needed, to more sophisticated methods. Indeed, magnetic resonance imaging (MRI) represents the examination method of choice for evaluating hypothalamic-pituitary-related endocrine diseases due to its ability to provide strongly-contrasted high-resolution multi-planar and spatial images. Specifically, MRI allows a detailed and precise anatomical study of the pituitary gland by differentiating between the anterior and posterior pituitary lobes. MRI identification of pituitary hyperintensity in the posterior part of the sella, now considered to be a clear marker of neurohypophyseal functional integrity, together with careful analysis of pituitary stalk shape and size, have provided the most striking recent findings contributing to the diagnosis and understanding of some forms of 'idiopathic' central diabetes insipidus.
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Affiliation(s)
- Stefano Ghirardello
- Institute of Pediatrics and Neonatology, Fondazione IRCCS "Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena ", University of Milan, Italy
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Bowden SA, Germak JA. Klinefelter syndrome presenting with precocious puberty due to a human chorionic gonadotropin (hCG)-producing mediastinal germinoma. J Pediatr Endocrinol Metab 2006; 19:1371. [PMID: 17220068 DOI: 10.1515/jpem.2006.19.11.1371] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Phowthongkum P. The second case of de novo intracranial germinoma association with Klinefelter's syndrome. ACTA ACUST UNITED AC 2006; 66:332; author reply 332. [PMID: 16935655 DOI: 10.1016/j.surneu.2006.05.041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2006] [Accepted: 05/25/2006] [Indexed: 10/24/2022]
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Yoon CY, Kang SG, Yoon DH, Lee JH, Kim IS, Yoon DK. Mixed germ cell tumor in intra-abdominal testis associated with ipsilateral ectopic dysplastic kidney. Urology 2006; 68:427.e9-11. [PMID: 16904474 DOI: 10.1016/j.urology.2006.02.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2005] [Revised: 01/05/2006] [Accepted: 02/20/2006] [Indexed: 11/16/2022]
Abstract
Testicular tumor of the cryptorchid testis associated with renal dysplasia is relatively infrequent and indicates maldevelopment during embryogenesis. We report a case of a 31-year-old man with a mixed germ cell tumor found in an intra-abdominal testis associated with an ipsilateral ectopic dysplastic kidney. He underwent orchiectomy with partial cystectomy. Simple nephrectomy was also performed. No evidence of disease recurrence was found at 16 months of follow-up.
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Affiliation(s)
- Cheol Yong Yoon
- Department of Urology, Korea University College of Medicine, Seoul, Korea
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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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Nakata Y, Yagishita A, Arai N. Two patients with intraspinal germinoma associated with Klinefelter syndrome: case report and review of the literature. AJNR Am J Neuroradiol 2006; 27:1204-10. [PMID: 16775265 PMCID: PMC8133920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
We report 2 cases of intraspinal germinoma associated with Klinefelter syndrome. In one patient, spinal cord atrophy was observed at the upper and lower ends of the intraspinal tumor. Brain atrophy was observed in both cases. Germinoma should be included in the differential diagnosis if an intraspinal tumor is observed in a patient with Klinefelter syndrome.
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Affiliation(s)
- Y Nakata
- Department of Neuroradiology, Tokyo Metropolitan Neurological Hospital, 2-6-1 Musashi-dai, Fuchu, Tokyo 183-0042, Japan
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Abstract
OBJECTIVES The value of surgical intervention in the management of intracranial germ cell tumors remains controversial. PATIENTS We report three patients who presented with rapid deterioration of consciousness but resulted in complete remission of the tumor after emergency surgery for both diagnostic (biopsy) and therapeutic (for hydrocephalus) purposes followed by prompt initiation of radiochemotherapy. CONCLUSION For management of these rapidly deteriorating patients, immediate histological verification and avoidance of delay in the induction of radiochemotherapy are essential. Thus, emergency surgery with a less invasive procedure is the first choice of treatment, i. e., endoscopic surgery for pineal region tumor and CT-guided biopsy for basal ganglia tumor.
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Affiliation(s)
- H Nishioka
- Department of Neurosurgery, Tokyo Medical University, Tokyo, Japan.
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Uchino M, Haga D, Mito T, Kuramitsu T, Nakamura N. Primary midbrain cystic germinoma mimicking glioma: a case with neuroendoscopic biopsy. J Neurooncol 2006; 79:255-8. [PMID: 16557347 DOI: 10.1007/s11060-006-9138-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2005] [Accepted: 02/14/2006] [Indexed: 12/19/2022]
Abstract
Intracranial germinoma arising primarily in the midbrain is extremely rare. We present the first reported case of cystic midbrain germinoma that lacked evident solid components and mimicked a midbrain glioma. In a 22-year-old man with headache and diplopia, magnetic resonance imaging showed a ring-enhancing lesion in the midbrain. The preoperative diagnosis included brain stem glioma, metastasis, and neuroepithelial cyst. A neuroendoscopic biopsy specimen provided a histologic diagnosis of germinoma. The patient responded well to chemotherapy and radiotherapy. The case illustrates the diagnostic value of neuroendoscopic biopsy in the differential diagnosis of brainstem lesions in adult. The possibilities considered should now include germinoma.
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Affiliation(s)
- Masafumi Uchino
- Department of Neurosurgery, Saiseikai Yokohama-shi Nambu Hospital, Yokohama-shi, Kanagawa-ken, Japan.
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Rushing EJ, Sandberg GD, Judkins AR, Vezina G, Kadom N, Myseros JS, Packer RJ, Santi M. Germinoma: unusual imaging and pathological characteristics. Report of two cases. J Neurosurg 2006; 104:143-8. [PMID: 16506503 DOI: 10.3171/ped.2006.104.2.12] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Primary germ cell neoplasms of the central nervous system typically develop as midline mass lesions during the first three decades of life. The authors present two cases with atypical clinicopathological features that stimulate discussion on the diagnosis and management of these tumors. The first patient was an 11-year-old boy of Japanese-American heritage who presented with a 6-month-long history of cognitive decline, difficulty swallowing, unsteady gait, and intermittent right-sided posturing. The initial magnetic resonance (MR) image of the brain displayed a mildly increased T2 signal in the cerebral peduncles, putamen, and globus pallidus bilaterally. Follow-up MR images showed an increase in the T2 signal abnormality in the left basal ganglia. The second patient was a 10-year-old Caucasian boy who presented with diabetes insipidus and subsequently displayed progressive fatigue, involuntary eye and mouth movements, and obsessive-compulsive behavior. An MR image demonstrated signs of mineral deposition and foci of increased T2 signal in both basal ganglia. Follow-up MR images demonstrated a progressive increase in the T2 signal (which was then located within the mesial temporal lobe). A biopsy performed on the left thalamic lesion in the first patient revealed a germinoma. The patient was treated with chemotherapy and died 2 years later. The second patient underwent a lumbar puncture, which demonstrated an elevated level of beta-human chorionic gonadotropin. Despite the lack of a mass on MR images in this child, the need for a tissue diagnosis prompted the authors to perform an anterior temporal lobectomy. The diagnosis of diffuse germinoma was confirmed, and the patient was treated with adjunctive chemotherapy. Although uncommon, germ cell tumors can present outside the midline and exhibit a multifocal growth pattern.
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Affiliation(s)
- Elisabeth J Rushing
- Department of Neuropathology and Ophthalmic Pathology, Armed Forces Institute of Pathology, Washington, DC 20306-6000, USA.
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Gottschling S, Graf N, Meyer S, Reinhard H, Krenn T, Rohrer T. Intracranial germinoma: a rare but important differential diagnosis in children with growth retardation. Acta Paediatr 2006; 95:302-5. [PMID: 16497640 DOI: 10.1080/08035250500430262] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
AIM Intracranial germinoma is a rare malignant tumour in childhood with an excellent prognosis under adequate therapy. Finding the right diagnosis at an early stage is difficult because of the slow-growing tumour and the resulting lack of clinical symptoms. METHODS Our patients with histologically secured germinoma were retrospectively assessed concerning growth retardation, pituitary hormone status, magnetic resonance imaging scan results and clinical symptoms to find out whether there is a leading parameter. RESULTS In all our patients, the leading symptom was growth retardation of at least 2 y before being diagnosed. CONCLUSION Growth retardation seems to be a very early sign of germinoma in the suprasellar region. Therefore, early neuroradiological imaging combined with pituitary hormone status should be considered in every paediatric patient with a history of secondary growth retardation.
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Affiliation(s)
- Sven Gottschling
- Department of Paediatric Haematology and Oncology, University Children's Hospital Homburg, Germany.
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Affiliation(s)
- Kevin P Banks
- United States Army, MCHE-DR, 3851 Roger Brooke Dr., Fort Sam Houston, TX 78234, USA.
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Prosch H, Grois N, Bökkerink J, Prayer D, Leuschner I, Minkov M, Gadner H. Central diabetes insipidus: Is it Langerhans cell histiocytosis of the pituitary stalk? A diagnostic pitfall. Pediatr Blood Cancer 2006; 46:363-6. [PMID: 15942956 DOI: 10.1002/pbc.20027] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Central diabetes insipidus (CDI) is a rare disorder that may be caused by a variety of diseases. In pediatric and adolescent patients the most common causes for CDI are Langerhans cell histiocytosis (LCH) and germinoma. To avoid a potentially hazardous biopsy of the hypothalamic pituitary region it is recommended to evaluate patients with CDI carefully to identify potential extracranial lesions. Since LCH is the most common systemic disease that may cause CDI, special focus is paid to the identification of LCH lesions. We report on a 9(1/2) year old girl who presented with central diabetes insipidus and a thickening of the pituitary stalk on magnetic resonance imaging. Diagnostic workup revealed a history of recurrent ear infections and a compressed 6th thoracic vertebral body on radiographs. Based on these findings LCH was anticipated. Upon growth of the pituitary stalk lesion the patient was treated with LCH standard chemotherapy. After an initial shrinkage of the lesion, a further growth of the pituitary stalk lesion was observed and the tumor was resected. Histopathology revealed germinoma. This case underscores the importance of a istopathologically proven diagnosis in patients with HPR tumors before the initiation of a specific therapy, even if the clinical findings are highly suggestive.
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Affiliation(s)
- Helmut Prosch
- Children's Cancer Research Institute, Vienna, Austria
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