Abstract
Primary intracranial germinoma is a rare central nervous system tumor that usually arises in the pineal and the supra-sellar region. Here, we report a rare case of primary intracavernous sinus germinoma with an atypical extension pattern, with a comparison to germinomas originating from the cavernous sinus as described in the existing literature. A 12-year-old boy was admitted to our hospital with the chief complaint of the left-side ptosis and double vision. Magnetic resonance imaging showed homogenous enhanced mass lesion in the pineal region together with mass lesions in the lateral ventricle, left cavernous sinus, and temporal lobe, extending into the left masticator space. The enhanced mass in the intracavernous sinus originated from the cavernous sinus. Endoscopic third ventriculostomy and tumor biopsy was done. Pathological diagnosis was pure germinoma. After six courses of chemotherapy followed by radiation therapy, all the lesions decreased in size significantly. Only faint enhancement around the masticator space remained. We report a rare case of a germinoma that developed mainly in the cavernous sinus with additional tumor masses in the pineal region, ventricles, and temporal lobe. Although the lesions shrank significantly on the post-chemoradiation imaging, a long follow-up is necessary not only to check for symptoms, but also monitor imaging findings for possible serial changes in the residual region of the masticator space.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Abbreviations
- AFP:
-
Alpha fetoprotein
- ETV:
-
Endoscopic third ventriculostomy
- HCG-β:
-
Beta human chorionic gonadotropin
- MRI:
-
Magnetic resonance imaging
References
Baussart B, Lepeintre JF, Condette-Auliac S, Dupuy M, Gaillard S (2007) Primitive intracranial trigeminal nerve germinoma. Case report. Neurochirurgie 53:43–46 (French)
Budohoski KP, O’Donovan DG, Harris F, Santarius T (2016) Germinoma of the medulla oblongata – a case report. Br J Neurosurg 30:348–350
Duron L, Sadones F, Thiasse P, Cellier C, Alapetite C, Doz F, Frappaz D, Brisse HJ (2018) Loco-regional extensions of central nervous system germ cell tumors: a retrospective radiological analysis of 100 patients. Neuroradiology 60:27–34
Endo T, Kumabe T, Ikeda H, Shirane R, Yoshimoto T (2002) Neurohypophyseal germinoma histologically misidentified as granulomatous hypophysitis. Acta Neurochir 144:1233–1237
Fukushima T, Takemura Y, Tsugu H, Iwaasa M, Nabeshima K, Takano K, Utsunomiya H (2007) Neurohypophyseal granulomatous germinoma invading the right cavernous sinus: case report and review of the literature. Pediatr Neurosurg 43:297–302
Gupta R, Songara A (2015) Management of dual intracranial germinoma by radiotherapy alone. J Pediatr Neurosci 10:38–40
Hao S, Li D, Feng J, Wang L, Wu Z, Zhang J, Zhang L (2013) Primary medulla oblongata germinomas: two case reports and review of the literature. World J Surg Oncol 11:274
Kwak R, Shatzkes D (2009) Transdural spread of glioblastoma through the foramen ovale with presentation as a masticator space mass. Am J Neuroradiol 30:808–810
Luo Z, Qian Z, Yang K, Liu H, Zhang W, Zeng Y (2017) Primary germinoma originating from the insular lobe: a case report and review of the literature. World Neurosurg 98:871.e1–871.e7
Muroi A, Takano S, Fukushima T, Shimizu T, Matsumura A (2012) Intracranial germinoma manifesting as cavernous sinus syndrome--case report. Neurol Med Chir (Tokyo) 52:754–756
Poon W, Ng HK, Wong K, South JR (1988) Primary intrasellar germinoma presenting with cavernous sinus syndrome. Surg Neurol 30:402–405
Sano K (1990) Pathogenesis of intracranial germ cell tumors reconsidered. J Neurosurg 90:258–264
Torremocha F, Hadjadj S, Menet E, Kas A, Bourgeois H, Levillain P, Bataille B, Maréchaud R (2002) [Pituitary germinoma presenting as a pseudotumoral lymphocytic hypophysitis in a man]. Ann Endocrinol (Paris) 63:13–17 (French)
Utsuki S, Oka H, Tanizaki Y, Kondo K, Fujii K (2005) Radiological features of germinoma arising from atypical locations–three case reports. Neurol Med Chir (Tokyo) 45:268–271
Villano JL, Virk IY, Ramirez V, Propp JM, Engelhard HH, McCarthy BJ (2010) Descriptive epidemiology of the central nervous system germ cell tumors: nonpineal analysis. Neuro-Oncology 12:257–264
Yip CM, Tseng HH, Hsu SS, Liao WC, Chen JY, Chen CH, Chang CY (2014) Dyspnea and choking as presenting symptoms in primary medulla oblongata germinoma. Surg Neurol Int 19:S1170–S1174
Yonezawa H, Shinsato Y, Obara S, Oyoshi T, Hirano H, Kitajima S, Arita K (2010) Germinoma with syncytiotrophoblastic giant cells arising in the corpus callosum –case report. Neurol Med Chir (Tokyo) 50:588–591
Zhou ZH, Zhang HB, Rao J, Bian XW (2014) Clinical diagnostic dilemma of intracranial germinoma manifesting as wide skull base extension. J Craniofac Surg 25:e467–e470
Acknowledgements
The authors would like to thank Alexander Zaboronok and Thomas Mayers of the University of Tsukuba Medical English Communications Center for the proofreading of this manuscript.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Ethical approval
This article does not contain any studies with animals performed by any of the authors.
Informed consent
Informed consent was obtained from the next of kin.
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Sakakura, K., Tsurubuchi, T., Masumoto, T. et al. Primary cavernous sinus germinoma with atypical extension pattern: a case report and review of the literature. Childs Nerv Syst 35, 1615–1619 (2019). https://doi.org/10.1007/s00381-019-04092-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00381-019-04092-5