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Neuroradiology Case of the Week

Case 344

August 2008

Hisao Nakamura, MD

Clinical Presentation: Patient is a 22-year old woman presenting with symptom of headaches, nausea, vomiting, and flashing lights.

Imaging Findings: Multifocal germinoma.

Diagnosis: Multifocal germinoma

Discussion: In this case, biopsy demonstrated germinoma (AFP was normal). Both chemo and radiation therapy was performed. Germ cell tumors (GCT) affect not only gonads but also extragonadal tissue The testes and ovaries are the most common sites. However, GCTS also rarely occur in the central nervous system, such as the pineal gland, neurohypophysis, and sacrococcygeal region. CNS germinomas have a propensity to hug the midline near the 3rd ventricle (pineal gland, suprasellar, basal ganglia and thalami). These sites are occupied 80-90%. Other sites include intraventicular, intrasella, and cerebral hemisphere. Multiple site involvement such as this case is considered metastatic in USA but synchronous in Canada and Europe. CT finding is homogeneous hyperdense mass. MRI findings are homogeneous and similar to that of gray matter. After contrast, the strong homogeneous enhancement is seen.

References:

1. Banks KP, Brown SJ. AJR teaching file: solid masses of the pineal region. AJR Am J Roentgenol. 2006 Mar;186(3 Suppl):S233-5. [PubMed]
2. Osborn AG, Blaser S, Salzman KL. Germinoma. IN: Diagnostic Imaging: Brain, Elsevier; 2004:132-135.