Journal of Pediatric Neurology 2023; 21(02): 118-121
DOI: 10.1055/s-0042-1751263
Case Report

Basal Ganglia Germinoma in an Adolescent: A Case Report

Shilpa Kulkarni
1   Division of Pediatric Neurosciences, Bai Jerbai Wadia Hospital For Children, Mumbai, India
,
Anish Ainapure
1   Division of Pediatric Neurosciences, Bai Jerbai Wadia Hospital For Children, Mumbai, India
,
Foram Gala
1   Division of Pediatric Neurosciences, Bai Jerbai Wadia Hospital For Children, Mumbai, India
,
Payal Shah
1   Division of Pediatric Neurosciences, Bai Jerbai Wadia Hospital For Children, Mumbai, India
,
Vrushabh Gavali
1   Division of Pediatric Neurosciences, Bai Jerbai Wadia Hospital For Children, Mumbai, India
› Author Affiliations

Abstract

Germ cell tumors are rare tumors and may pose a diagnostic dilemma. We present a 15-year-old boy with insidious onset right hemiparesis followed by polyuria and polydipsia. Later, he also developed cognitive decline and speech disturbances. Serial magnetic resonance images (MRIs) over a 2-year period showed progressive atrophy of the left caudate nucleus, along with Wallerian degeneration of the left internal capsule and crus of midbrain. Further in the course, imaging revealed an ill-defined signal intensity involving left ganglio-capsulo-thalamic region with increased perfusion which was suggestive of basal ganglia germinoma. Beta human chorionic gonadotropin levels were mildly elevated. This case illustrates an uncommon presentation of a central nervous system germinoma which is often misdiagnosed in the early stages because of its atypical symptomatology and MRI findings.



Publication History

Received: 08 April 2022

Accepted: 23 May 2022

Article published online:
16 August 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 
  • References

  • 1 Ostrom QT, Gittleman H, Xu J. et al. CBTRUS statistical report: primary brain and other central nervous system tumors diagnosed in the United States in 2009-2013. Neuro-oncol 2016; 18 (Suppl. 05) v1-v75
  • 2 Borde TD, Arimappamagan A, Srinivas D. et al. Intracranial germ cell tumors: spectrum of disease in an indian cohort and management strategies. J Neurosci Rural Pract 2018; 9 (03) 291-297
  • 3 Echevarría ME, Fangusaro J, Goldman S. Pediatric central nervous system germ cell tumors: a review. Oncologist 2008; 13 (06) 690-699
  • 4 Abdelhalim AN, Alberico RA. Pediatric neuroimaging. Neurol Clin 2009; 27 (01) 285-301 , x
  • 5 Wataya T, Ishizaki R, Kitagawa M, Tashiro Y. Germinoma in the bilateral basal ganglia presented with cognitive deterioration. Childs Nerv Syst 2015; 31 (06) 953-958
  • 6 Phi JH, Kim SK, Lee YA. et al. Latency of intracranial germ cell tumors and diagnosis delay. Childs Nerv Syst 2013; 29 (10) 1871-1881
  • 7 Ozelame RV, Shroff M, Wood B. et al. Basal ganglia germinoma in children with associated ipsilateral cerebral and brain stem hemiatrophy. Pediatr Radiol 2006; 36 (04) 325-330
  • 8 Almubarak S, Gan YC, Steinbok P. et al. Occurrence of basal ganglia germ cell tumors without a mass. Arch Neurol 2009; 66 (06) 789-792
  • 9 Allen J, Chacko J, Donahue B. et al. Diagnostic sensitivity of serum and lumbar CSF bHCG in newly diagnosed CNS germinoma. Pediatr Blood Cancer 2012; 59 (07) 1180-1182
  • 10 Hu M, Guan H, Lau CC. et al. An update on the clinical diagnostic value of β-hCG and αFP for intracranial germ cell tumors. Eur J Med Res 2016; 21 (01) 10
  • 11 Aihara Y, Watanabe S, Amano K. et al. Placental alkaline phosphatase levels in cerebrospinal fluid can have a decisive role in the differential diagnosis of intracranial germ cell tumors. J Neurosurg 2018; 131 (03) 687-694
  • 12 Rasalkar DD, Chu WCW, Cheng FWT, Paunipagar BK, Shing MK, Li CK. Atypical location of germinoma in basal ganglia in adolescents: radiological features and treatment outcomes. Br J Radiol 2010; 83 (987) 261-267
  • 13 Li B, Lv W, Li C. et al. Comparison between craniospinal irradiation and limited-field radiation in patients with non-metastatic bifocal germinoma. Cancer Res Treat 2020; 52 (04) 1050-1058
  • 14 Miyanohara O, Takeshima H, Kaji M. et al. Diagnostic significance of soluble c-kit in the cerebrospinal fluid of patients with germ cell tumors. J Neurosurg 2002; 97 (01) 177-183