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. 2014:2014:936937.
doi: 10.1155/2014/936937. Epub 2014 Feb 9.

Germinoma with involvement of midline and off-midline intracranial structures

Monica Graciela Loto  1 , Karina Danilowicz  1 , Santiago González Abbati  2 , Rafael Torino  2 , Alejandro Misiunas  1
Affiliations

Germinoma with involvement of midline and off-midline intracranial structures

Monica Graciela Loto et al. Case Rep Endocrinol. 2014.

Abstract

Germinomas are malignant intracranial germ tumors, usually found in suprasellar regions. Less than 10% are localized in off-middle structures, and synchronous involvement of both structures has only exceptionally been published. A case of an 18-year-old male patient with progressive right-sided hemiparesis and panhypopituitarism was reviewed. Brain MRI showed a solid mass involving pituitary and hypothalamus with thickening of pituitary stalk, high intensity lesions on T2-weighted imaging in left internal capsule, caudate nucleus, globus pallidus, and mild atrophy of the left internal capsule and cerebral peduncle. Nonadenomatous lesions were considered in the differential diagnosis. Alfa-fetoprotein (AFP) levels were negative in both serum and cerebrospinal fluid (CSF), while β -human chorionic gonadotrophin ( β -HCG) levels were slightly increased in CSF. A transsphenoidal biopsy identified a germinoma. Four cycles of chemotherapy with bleomicine, etoposide, and cysplatin were given, followed by radiotherapy, but patients died due to a recidiva. Conclusion. Germinoma must be considered in patients with insipidus diabetes with a sellar mass with thickening of pituitary stalk; and ectopic germinoma must be suspected in patients with slowly progressive hemiparesis with cerebral hemiatrophy. Even with a rare condition, colocalization of midline and off-midline germinoma must be suspected in the presence of these typical signs of both localizations.

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Figures

Figure 1
Figure 1
Solid mass involving hypophysis and hypothalamus with marked thickening of the pituitary stalk (a), with enhancement after gadolinium (b).
Figure 2
Figure 2
T2-weighted images reveal hyperintense lesions over the left internal capsule (a) and over corona radiata (b).
Figure 3
Figure 3
T2-weighted images reveal an atrophic left midbrain peduncle.
Figure 4
Figure 4
Axial T1-weighted (a) and sagittal T1-weighted (b) MRI after gadolinium enhancement one month after chemotherapy, MRI showed resolution of pituitary-hypothalamic mass, with a marked reduction in stalk-thickness.
See this image and copyright information in PMC

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