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BMC Neurology
Published in: BMC Neurology 1/2016

Open Access 01-12-2016 | Case report

Radiographic occult cerebellar germinoma presenting with progressive ataxia and cranial nerve palsy

Authors: Noriaki Minami, Kazuhiro Tanaka, Hidehito Kimura, Takanori Hirose, Tatsuya Mori, Masahiro Maeyama, Hiroaki Sekiya, Takeshi Uenaka, Satoshi Nakamizo, Hiroaki Nagashima, Katsu Mizukawa, Tomoo Itoh, Takashi Sasayama, Eiji Kohmura

Published in: BMC Neurology | Issue 1/2016

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Abstract

Background

Although the usefulness of susceptibility-weighted imaging (SWI) for detecting basal ganglia germinoma has been reported, the technique is not widely used. We recently encountered an unusual case of primary cerebellar germinoma, presenting with progressive ataxia and cranial nerve palsy, characterized by gradually enlarging low-intensity lesions visible with both T2*-weighted imaging (T2*WI), which were the key to the diagnosis.

Case presentation

A 30-year-old man was referred to our hospital because of slowly progressive dizziness and mild ataxia. Magnetic resonance imaging (MRI) revealed a small, low-intensity spot in the left cerebellar peduncle on the T2*WI and SWI without enhancement. Cerebral angiography revealed no vascular abnormality. The serum α-fetoprotein value was normal. A steroid-pulse was administered as a therapeutic and diagnostic trial, but the symptoms improved little. The patient was discharged from the hospital but soon developed brainstem dysfunction, characterized by dyspnea or hiccups, and he was readmitted. T2*WI imaging revealed expanded and extended spotty lesions in the cerebellum and brainstem, which had not enhanced with contrast agent previously. Targeted stereotactic biopsy of the newly enhanced cerebellar lesion was performed; histopathological examination of the tissue revealed pure germinoma. Serum and cerebral spinal fluid values of beta-human chorionic gonadotropin were not significantly elevated. Chemotherapy with carboplatin and etoposide was initiated. The enhanced lesion disappeared promptly, but the patient continued to require assisted automatic ventilation because of paralysis of respiratory muscles.

Conclusions

We conclude that enlarging low-intensity lesions on T2*WI and SWI may be a reliable clue to the diagnosis of germinomas, irrespective of their location, even without enhancement. Biopsy of the tumor at an early stage is the only way to make the diagnosis conclusively and enable prompt start of treatment.
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Literature
1.
Committee of Brain Tumor Registry of Japan. Report of Brain Tumor Registry of Japan (1969–1996). Neurologia medico-chirurgica 2003, 43 Suppl:i-vii, 1–111
2.
Fujimaki T. Central nervous system germ cell tumors: classification, clinical features, and treatment with a historical overview. J Child Neurol. 2009;24(11):1439–45.CrossRefPubMed
3.
Surawicz TS, McCarthy BJ, Kupelian V, Jukich PJ, Bruner JM, Davis FG. Descriptive epidemiology of primary brain and CNS tumors: results from the Central Brain Tumor Registry of the United States, 1990–1994. Neuro Oncol. 1999;1(1):14–25.PubMedPubMedCentral
4.
Lee J, Lee BL, Yoo KH, Sung KW, Koo HH, Lee SJ, et al. Atypical basal ganglia germinoma presenting as cerebral hemiatrophy: diagnosis and follow-up with 11C-methionine positron emission tomography. Childs Nerv Syst. 2009;25(1):29–37.CrossRefPubMed
5.
El Abbadi N, Maaqili MR, Arkha Y, Amarti A, Bellakhdar F. Cerebellar primary germinoma. Case report. Neurochirurgie. 2002;48(4):351–4.PubMed
6.
Evanson EJ, Lewis PD, Colquhoun IR. Primary germinoma of the posterior cranial fossa: a case report. Neuroradiology. 1997;39(10):716–8.CrossRefPubMed
7.
Maiuri F, Cappabianca P, Del Basso De Caro M, Esposito F, de Divitiis E. Primary cerebellar germinomas of the posterior fossa. Br J Neurosurg. 2004;18(3):284–9.CrossRefPubMed
8.
Ng HK, Poon WS. Primary germinoma of the posterior fossa with CSF and extracranial metastases. Br J Neurosurg. 1990;4(3):239–42.CrossRefPubMed
9.
Ichikawa T, Hamazaki S, Sakai N, Otsuki Y, Wataya T, Kambara H, et al. Mixed germ cell tumor and hemangioblastoma in the cerebellum: report of a rare coexistence. Brain Tumor Pathol. 2011;28(3):279–84.CrossRefPubMed
10.
Nakase H, Ohnishi H, Touho H, Karasawa J, Tsunoda S. Cerebellar primary germ-cell tumor in a young boy. Brain Dev. 1994;16(5):396–8.CrossRefPubMed
11.
Shenoy AS, Desai HM, Tyagi DK, Savant HV, Kavishwar VS, Balasubramaniam M. Primary yolk sac tumor of the cerebellar vermis: a case report. Indian J Pathol Microbiol. 2014;57(2):278–80.CrossRefPubMed
12.
Matsutani M, Sano K, Takakura K, Fujimaki T, Nakamura O, Funata N, et al. Primary intracranial germ cell tumors: a clinical analysis of 153 histologically verified cases. J Neurosurg. 1997;86(3):446–55.CrossRefPubMed
13.
Lou X, Ma L, Wang FL, Tang ZP, Huang H, Cai YQ, et al. Susceptibility-weighted imaging in the diagnosis of early basal ganglia germinoma. AJNR Am J Neuroradiol. 2009;30(9):1694–9.CrossRefPubMed
14.
Chavhan GB, Babyn PS, Thomas B, Shroff MM, Haacke EM. Principles, techniques, and applications of T2*-based MR imaging and its special applications. Radiographics. 2009;29(5):1433–49.CrossRefPubMedPubMedCentral
15.
Okochi Y, Nihashi T, Fujii M, Kato K, Okada Y, Ando Y, et al. Clinical use of (11)C-methionine and (18)F-FDG-PET for germinoma in central nervous system. Ann Nucl Med. 2014;28(2):94–102.CrossRefPubMed
16.
Rasalkar DD, Chu WC, Cheng FW, 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):261–7.CrossRefPubMedPubMedCentral
17.
Yoshida K, Nakao Y, Yamamoto T, Mori K, Maeda M. Germinoma in the fourth ventricle. Acta Neurochir. 2003;145(9):789–92. discussion 792.CrossRefPubMed
Metadata
Title
Radiographic occult cerebellar germinoma presenting with progressive ataxia and cranial nerve palsy
Authors
Noriaki Minami
Kazuhiro Tanaka
Hidehito Kimura
Takanori Hirose
Tatsuya Mori
Masahiro Maeyama
Hiroaki Sekiya
Takeshi Uenaka
Satoshi Nakamizo
Hiroaki Nagashima
Katsu Mizukawa
Tomoo Itoh
Takashi Sasayama
Eiji Kohmura
Publication date
01-12-2016
Publisher
BioMed Central
Published in
BMC Neurology / Issue 1/2016
Electronic ISSN: 1471-2377
DOI
https://doi.org/10.1186/s12883-015-0516-9

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