Treatment Outcome of a β-hCG Secreting Intracranial Germ Cell Tumor in an Adult Filipino Using Definitive Chemotherapy Followed by Radiotherapy: A Case Report

Abstract

We report a case of a 24-year-old Filipino male who complained of general weakness, polydipsia, weight loss, bitemporal headaches, loss of libido and behavioral changes. Endocrine work-up revealed neurogenic diabetes insipidus and panhypopituitarism. Brain MRI showed multiple intracranial tumors in the left frontal lobe, pineal and suprasellar region with moderate non-communicating hydrocephalus. Intracranial mass biopsy with ventriculo-peritoneal shunting was done. Histopathology of the mass and CSF revealed a germinoma. He underwent chemoradiotherapy while on maintenance hormone replacement.

Keywords: Germ cell tumors (GCTs); diabetes insipidus; germinoma; hypopituitarism; β-hCG.

Figure 1

(A) Pretreatment cranial MRI in sagittal section. There was a 4.5 x 2.4 x 2.2 cm mixed signal predominantly isointense lobulated mass in the left frontal lobe parasagittal region extending across the midline with involvement of the anterior corpus callosum to the right frontal lobe (thick arrow). The mass encroached into the left frontal horn and anterior third ventricle. Mixed signal lesions were also seen in the pineal gland about 3.3 x 2.4 x 2.2 cm and in the suprasellar region measuring about 1.7 x 0.9 cm (thin arrow). There was also moderate non-communicating hydrocephalus. (B) Postreatment cranial MRI in sagittal section showing tumor size reduction (1.6 x 0.8 cm) in the frontal lobe and resolution of suprasellar and pineal masses.

Figure 2

Pathophysiology of clinical presentation of intracranial germ cell tumor. (*) represents signs and symptoms present in the patient.