Bilateral germinoma involving the basal ganglia and cerebral white matter

Abstract

We describe radiologic findings of germinoma involving bilateral basal ganglia and cerebral white matter. In the early stage, T1-weighted MR images showed hyperintense areas in the bilateral globi pallidi. Later, T2-weighted images showed hyperintense areas involving bilateral white matter. The MR imaging findings reported here could help facilitate the early diagnosis of germ cell tumors in young patients.

Fig 1.

Axial 0.5T MR images obtained at the onset of the disease. T1-weighted image (spin-echo 662/15 [TR/TE]) shows mild hyperintense areas in the globi pallidi bilaterally (arrows).

Fig 2.

Axial and sagittal MR images obtained 2 years after the onset of disease on 1.5T unit. A, T2-weighted image (spin-echo, 3000/90) shows hypointense areas with small hyperintense foci in the bilateral globi pallidi (arrowheads) and diffuse hyperintense areas in the bilateral internal capsule and surrounding cerebral white matter predominantly in the left side (arrows). B, Postcontrast T1-weighted image (spin-echo, 600/15) shows tiny enhancement in the left globus pallidus (arrows). C, Postcontrast T1-weighted image (spin-echo 600/15) in the sagittal plane taken on another day shows no abnormality in the sella/suprasellar and pineal region.

Fig 3.

Histopathologic examination of a specimen obtained from left lentiform nucleus by stereotactic biopsy. Hematoxylin and eosin staining shows two different types of cells: large atypical cells containing large, round, vesicular nuclei with irregular and pleomorphic nucleoli (tumor cells), and infiltrating lymphocytes (original magnification, ×200). Placental alkaline phosphatase staining shows positive tumor cells (not shown).