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Brasfield L, Tucker S, Levy M, Crawford JR. Suprasellar pure germinoma mimicking low-grade glioma on neuroimaging. BMJ Case Rep 2023; 16:e254900. [PMID: 37487652 PMCID: PMC10373663 DOI: 10.1136/bcr-2023-254900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/26/2023] Open
Affiliation(s)
- Leila Brasfield
- Pediatrics, Children's Hospital Orange County, Orange, California, USA
| | - Suzanne Tucker
- Department of Pathology, Rady Children's Hospital, San Diego, California, USA
| | - Michael Levy
- Neurosurgery, University of California San Diego, San Diego, California, USA
| | - John Ross Crawford
- Pediatrics, Children's Hospital Orange County, Orange, California, USA
- Pediatrics, University of California Irvine, Irvine, California, USA
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Primary midbrain germinomas: Report of a rare case with an updated review of the literature. Clin Neurol Neurosurg 2023; 227:107643. [PMID: 36863221 DOI: 10.1016/j.clineuro.2023.107643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 02/08/2023] [Accepted: 02/10/2023] [Indexed: 03/04/2023]
Abstract
Intracranial germinomas are most commonly extra-axial germ cell tumors that are predominantly found in the pineal and suprasellar regions. Primary intra-axial midbrain germinomas are extremely rare, with only eight reported cases. Here we present a 30-year-old man who presented with severe neurological deficits, with an MRI that showed a heterogeneously enhancing mass with ill-defined margins in the midbrain, and with surrounding vasogenic edema extending to the thalamus. The presumptive preoperative differential diagnosis included glial tumors and lymphoma. The patient underwent a right paramedian suboccipital craniotomy and biopsy obtained through the supracerebellar infratentorial transcollicular approach. The histopathological diagnosis was reported as pure germinoma. After patient discharge, he received chemotherapy with carboplatin and etoposide, followed by radiotherapy. Follow-up MRI at up to 26 months showed no contrast-enhancing lesions but a mild T2 FLAIR hyperintensity adjacent to the resection cavity. Differential diagnosis of midbrain lesions can be challenging and should include glial tumors, primary central nervous system lymphoma, germ cell tumors, and metastasis. Accurate diagnosis requires adequate tissue sampling. In this report, we present a very rare case of a primary intra-axial germinoma of the midbrain which is biopsied via a transcollicular approach. This report is also unique as it provides the first surgical video of an open biopsy and the microscopic appearance of an intra-axial primary midbrain germinoma via a transcollicular approach.
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3
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Miyake Y, Tateishi K, Oshima A, Hongo T, Satomi K, Ichimura K, Kato A, Iwashita H, Utsunomiya D, Yamamoto T. A case of midbrain germinoma: A literature review for radiographic and clinical features. Neurooncol Adv 2023; 5:vdad043. [PMID: 37215953 PMCID: PMC10195201 DOI: 10.1093/noajnl/vdad043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2023] Open
Affiliation(s)
- Yohei Miyake
- Department of Neurosurgery, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Kensuke Tateishi
- Corresponding author: Kensuke Tateishi, MD, PhD, Department of Neurosurgery, Yokohama City University, 3-9 Fukuura, Kanazawa, Yokohama 2360004, Japan ()
| | - Akito Oshima
- Department of Neurosurgery, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Takeshi Hongo
- Department of Neurosurgery, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Kaishi Satomi
- Department of Pathology, Kyorin University School of Medicine, Tokyo, Japan
| | - Koichi Ichimura
- Deparment of Brain Disease Translational Research, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Ayumi Kato
- Department of Radiology, Yokohama City University Hospital, Yokohama, Japan
| | - Hiromichi Iwashita
- Department of Pathology, Yokohama City University Hospital, Yokohama, Japan
| | - Daisuke Utsunomiya
- Department of Radiology, Yokohama City University Hospital, Yokohama, Japan
| | - Tetsuya Yamamoto
- Department of Neurosurgery, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
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Oshima A, Kimura T, Akabane A, Inoue T. Primary midbrain germinoma relapse-free for 5 years: A case report. Surg Neurol Int 2022; 13:574. [PMID: 36600775 PMCID: PMC9805627 DOI: 10.25259/sni_703_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 11/24/2022] [Indexed: 12/15/2022] Open
Abstract
Background The biology and clinical course of intracranial germinomas differ as per their location of occurrence. Germinoma of the primary midbrain is particularly rare, and its clinical features, treatment strategies, and long-term prognosis remain uncertain. Case Description A 39-year-old man who had been diagnosed with midbrain germinoma by open biopsy through the occipital transtentorial approach had undergone chemoradiotherapy and achieved 5 years with no recurrence. Conclusion Germinomas should be considered as a differential diagnosis for adolescents and young adult men with mesencephalic tumors, and reliable sampling followed by chemoradiotherapy must be performed.
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Affiliation(s)
- Akito Oshima
- Department of Neurosurgery, NTT Medical Center Tokyo, Tokyo, Japan,Department Neurosurgery, Yokohama City University, Graduate School of Medicine, Fukuura, Kanazawa-ku, Yokohama, Japan,Corresponding author: Akito Oshima, Department of Neurosurgery, NTT Medical Center Tokyo, Tokyo, Japan.
| | - Toshikazu Kimura
- Department of Neurosurgery, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Atsuya Akabane
- Gamma Knife Center, NTT Medical Center Tokyo, Tokyo, Japan
| | - Tomohiro Inoue
- Department of Neurosurgery, NTT Medical Center Tokyo, Tokyo, Japan
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Purkart TU, Seifert-Held T, Haybäck J, Holl E, Asslaber M, Payer F, Fazekas F. Vanishing midbrain mass lesion - A germinoma? J Neurol Sci 2019; 404:40-43. [PMID: 31325666 DOI: 10.1016/j.jns.2019.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 05/24/2019] [Accepted: 06/12/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Tadeja Urbanic Purkart
- Department of Neurology and Neuroradiology, Vascular and Interventional Radiology, Auenbruggerplatz 22, 8036 Graz, Medical University of Graz, Austria.
| | - Thomas Seifert-Held
- Department of Neurology, Medical University of Graz, Auenbruggerplatz 22, 8036 Graz, Austria.
| | - Johannes Haybäck
- Department of Neuropathology, Medical University of Graz, Austria; Institute of Pathology, Neuropathology and Molecular Pathology, Medical University Innsbruck, Austria; Institute of Pathology, University Clincs Magdeburg, Medical Faculty, Germany.
| | - Etienne Holl
- Department of Neurosurgery, Medical University of Graz, Austria.
| | - Martin Asslaber
- Department of Neuropathology, Medical University of Graz, Austria.
| | - Franz Payer
- Department of Neurology and Neuroradiology, Vascular and Interventional Radiology, Auenbruggerplatz 22, 8036 Graz, Medical University of Graz, Austria.
| | - Franz Fazekas
- Department of Neurology, Medical University of Graz, Auenbruggerplatz 22, 8036 Graz, Austria.
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Luo Z, Qian Z, Yang K, Liu H, Zhang W, Zeng Y. Primary Germinoma Originating from the Insular Lobe: A Case Report and Review of the Literature. World Neurosurg 2016; 98:871.e1-871.e7. [PMID: 28007604 DOI: 10.1016/j.wneu.2016.12.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 12/01/2016] [Accepted: 12/02/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND Primary intracranial germinomas occurring in the cerebral hemisphere are extremely rare, with only a few reported cases in the literature. We describe an unusual case of a primary germinoma that developed in the insular lobe, with little involvement in the basal frontal lobe. CASE DESCRIPTION A 19-year-old man presented with headache and vomiting. Magnetic resonance imaging showed a solitary, ring-like enhanced lesion in the left hemisphere, and a preliminary diagnosis of glioma was made. Surgery was performed, and the diagnosis of germinoma was made based on the histopathologic results. CONCLUSIONS The causes of ectopic germinomas of the midline structures of the brain are still unclear, but the theory of misplacement may partially clarify this phenomenon. Reflecting a lack of definitive management guidelines for atypical germinoma, the present patient was treated with focal radiotherapy around the lesion after surgery and achieved remission by 34 months postoperatively.
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Affiliation(s)
- Zhengxiang Luo
- Department of Neurosurgery, NanJing Brain Hospital affiliated with NanJing Medical University, NanJing, China
| | - Zhongrun Qian
- Department of Neurosurgery, NanJing Brain Hospital affiliated with NanJing Medical University, NanJing, China
| | - Kun Yang
- Department of Neurosurgery, NanJing Brain Hospital affiliated with NanJing Medical University, NanJing, China
| | - Hongyi Liu
- Department of Neurosurgery, NanJing Brain Hospital affiliated with NanJing Medical University, NanJing, China.
| | - Wenbin Zhang
- Department of Neurosurgery, NanJing Brain Hospital affiliated with NanJing Medical University, NanJing, China.
| | - Yanjun Zeng
- Biomechanics and Medical Information Institute, Beijing University of Technology, Beijing, China
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YASUHARA T, ICHIKAWA T, MIYOSHI Y, KUROZUMI K, MARUO T, YANAI H, DATE I. Primary Germinoma in the Medulla Oblongata -Case Report-. Neurol Med Chir (Tokyo) 2011; 51:326-9. [DOI: 10.2176/nmc.51.326] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Takao YASUHARA
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
| | - Tomotsugu ICHIKAWA
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
| | - Yasuyuki MIYOSHI
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
| | - Kazuhiko KUROZUMI
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
| | - Tomoko MARUO
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
| | - Hiroyuki YANAI
- Department of Pathology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
| | - Isao DATE
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
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8
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Koh EJ, Phi JH, Park SH, Kim IO, Cheon JE, Wang KC, Cho BK, Kim SK. Mixed germ cell tumor of the midbrain. Case Report. J Neurosurg Pediatr 2009; 4:137-42. [PMID: 19645547 DOI: 10.3171/2009.3.peds08290] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
This 14-year-old boy presented with left hemiparesis, gait disturbance, and multiple cranial nerve palsies. Magnetic resonance imaging revealed a multicystic mass with hemorrhagic fluid-fluid levels in the right midbrain, suggesting the presence of a cavernous malformation. Diffusion tensor imaging showed the mass to be close to the right corticospinal tract and ipsilateral medial lemniscus. Subtotal removal of the mass was performed via a right subtemporal approach. The histopathological diagnosis was of a mixed germ cell tumor (GCT) comprising mature teratoma and germinoma cells with syncytiotrophoblastic giant cells. The patient underwent postoperative chemotherapy and radiotherapy, and no tumor progression was found during 1 year of follow-up. Intracranial GCTs arise mainly in the pineal and the suprasellar area. Germ cell tumors in the brainstem are rare, with only 12 reported cases. Among these, 4 were in the midbrain and histologically were pure germinomas. To the authors' knowledge, this is the first reported case of a mixed GCT in the midbrain combining mature teratoma and germinoma cells.
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Affiliation(s)
- Eun Jung Koh
- Division of Pediatric Neurosurgery, Seoul National University College of Medicine, Seoul, Republic of Korea
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Maruya J, Narita E, Nishimaki K, Heianna J, Miyauchi T, Minakawa T. Primary cystic germinoma originating from the midbrain. J Clin Neurosci 2009; 16:832-4. [PMID: 19299138 DOI: 10.1016/j.jocn.2008.08.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2008] [Revised: 08/17/2008] [Accepted: 08/19/2008] [Indexed: 11/29/2022]
Abstract
A primary intracranial germinoma that involves the midbrain is rare. We describe an unusual case of primary cystic germinoma originating from the midbrain. A 29-year-old man presented with diplopia, and his MRI showed a cystic, ring-like enhanced lesion in the thalamo-mesencephalic junction. Open biopsy was performed and the diagnosis of germinoma was based upon the histopathological findings. Following chemotherapy and radiotherapy, the symptoms improved and the tumor disappeared. We propose that primary intracranial germinoma should be included in the differential diagnosis of midbrain tumors, because early diagnosis and appropriate treatment for midbrain germinoma improves clinical outcome.
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Affiliation(s)
- Jun Maruya
- Department of Neurosurgery, Akita Red Cross Hospital, 222-1 Nawashirosawa, Saruta, Kamikitate, Akita 010-1495, Japan.
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Yang DT, Rozen WM, Rickert CH, Lo PA. Primary pontomedullary germinoma in a 12 year old boy. J Clin Neurosci 2009; 16:321-5. [DOI: 10.1016/j.jocn.2007.08.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2007] [Accepted: 08/21/2007] [Indexed: 10/21/2022]
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11
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Germ cell tumors of the brainstem: report on two cases with pulmonary complications and a review of the literature. J Neurooncol 2009; 93:405-8. [PMID: 19139823 DOI: 10.1007/s11060-008-9780-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2008] [Accepted: 12/30/2008] [Indexed: 10/21/2022]
Abstract
Intracranial germ cell tumors most commonly present in the pineal and suprasellar regions. Rare cases of brainstem germ cell tumors have been described. Here, we present two cases with brainstem germ cell tumors and review the current literature. The two patients did well, in terms of disease control, but have significant morbidity related to respiratory issues. One patient remains ventilator dependent and the second died from respiratory arrest.
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12
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Primary midbrain germinoma. J Clin Neurosci 2008; 15:1282-4. [PMID: 18783953 DOI: 10.1016/j.jocn.2007.07.079] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2007] [Revised: 07/06/2007] [Accepted: 07/13/2007] [Indexed: 12/13/2022]
Abstract
An 11-year-old boy presented with a 4-month history of progressive holocranial headache, intermittent vomiting and visual blurring. Later, he began walking unsteadily, with progressive bilateral visual and hearing loss. He had had two episodes of abnormal tonic posturing the day prior to admission. On examination, the patient was drowsy and did not respond to commands. Imaging showed an enhancing midbrain mass with an exophytic component with hydrocephalus. Emergency ventriculoperitoneal shunt was performed, following which there was neurological improvement. Later he underwent a midline suboccipital craniectomy with vermian splitting and decompression of the exophytic component of the tumor from the midbrain. Biopsy of the tumor revealed a germinoma. Post-operatively, the patient received chemotherapy followed by radiotherapy. Primary midbrain germinoma is an extremely rare entity and to the best of our knowledge only two cases to date have been reported in the literature.
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