Elsevier

Pediatric Neurology

Volume 20, Issue 4, April 1999, Pages 312-314
Pediatric Neurology

Case Reports
Basal ganglia germinoma with progressive cerebral hemiatrophy

https://doi.org/10.1016/S0887-8994(98)00161-1Get rights and content

Abstract

The authors describe a 7-year-old Chinese-American female with a germinoma of the basal ganglia who presented with progressive hemiparesis and cerebral hemiatrophy. The additional finding of markedly elevated antiphospholipid antibodies suggests the possibility of an autoimmune pathogenesis for the progressive cerebral atrophy, as well as the later development of cognitive decline, tics, and obsessive-compulsive behaviors.

Introduction

Germinomas, which are believed to arise from the primordial germ cells, are the least malignant and most common of all germ cell tumors, a category that also includes embryonal cell carcinomas, endodermal sinus tumors, choriocarcinomas, and teratomas [1]. Germinomas represent 0.5-2.1% of all intracranial tumors and have a peak incidence in the latter half of the second decade [2]. Most of these tumors are found at the midline in the pineal or suprasellar regions. The authors present a case of an off-midline germinoma with progressive cerebral hemiatrophy.

Section snippets

Case report

A 7-year-old, previously healthy and developmentally normal, right-handed Chinese-American female developed a slowly progressive right-sided hemiparesis. Two months after the onset of these symptoms, computed tomography (not shown) revealed mineralization of the left globus palidus and expansion of the frontal horn of the left lateral ventricle, indicating tissue loss. Magnetic resonance imaging (MRI) revealed volume loss of the left caudate head and abnormal T2-weighted signal within the

Discussion

Although central nervous system (CNS) germinomas usually occur at the midline, several reports from Asian countries have found that up to 14% of these tumors arise within the basal ganglia or thalamus [2], [3], a geographic bias consistent with the Chinese background of the authors’ patient. A recent review of 42 cases also revealed a strong sex and age bias, with a male/female ratio of 20:1, with all patients between 6 and 20 years of age [2]. As was the case with the authors’ patient, these

References (10)

  • N. Ono et al.

    Factors affecting functional prognosis in survivors of primary central nervous system germinal tumors

    Surg Neurol

    (1994)
  • M.B. Horowitz et al.

    Central nervous system germinomas

    Arch Neurol

    (1991)
  • N. Tamaki et al.

    Germ cell tumors of the thalamus and the basal ganglia

    Childs Nerv Syst

    (1990)
  • W.K. Moon et al.

    Germinomas of the basal ganglia and thalamusMR findings and a comparison between MR and CT

    Am J Roentgenol

    (1994)
  • T. Maehara et al.

    Brain tumors with ipsilateral cerebral hemiatrophy

    Am J Neuroradiol

    (1983)
There are more references available in the full text version of this article.

Cited by (39)

  • Pediatric Basal Ganglia Region Tumors: Clinical and Radiologic Features Correlated with Histopathologic Findings

    2017, World Neurosurgery
    Citation Excerpt :

    In MRI, such tumors present as an ill-defined, heterogeneous enhancing mass with or without a cystic component.22-24 Hemiatrophy has been considered as a diagnostic sign and was observed in 9 cases (81.8%) in our series.25,26 Because the GCTs are not as rare as predicted, we recommend routine examination of tumor markers, including AFP and β-HCG, for patients with PGBRTs.

  • Clinical and Radiologic Features of Pediatric Basal Ganglia Germ Cell Tumors

    2016, World Neurosurgery
    Citation Excerpt :

    2) After reviewing our series and the previous reported cases, we observed that basal ganglia GCTs are predominantly located in the caput of caudate nucleus adjacent to the anterior horn of lateral ventricles. 3) Ipsilateral hemiatrophy has been considered as a diagnostic sign of basal ganglia GCTs, especially in the early stage.3,14-17 In our series, hemiatrophy was observed in 8 cases (66.7%) and occurred predominantly in ipsilateral cerebral peduncle, which probably because that most of the tumors enrolled in our study were large lesions associated with significant mass effect and subsequently occupied the subarachnoid space.

  • Basal Ganglia Germinoma in an Adult

    2016, World Neurosurgery
    Citation Excerpt :

    The features of basal ganglia germinoma on MRI are unremarkable; however, ipsilateral hemispheric brain atrophy was present in 12 of 29 patients (41%).8,14,15 Radiological studies have demonstrated that parenchymal atrophy is attributable to Wallerian degeneration.20,21 CNS metastasis is rare.

View all citing articles on Scopus
View full text