Brain Tumor Research and Treatment

The Korean Brain Tumor Society (대한뇌종양학회)
권호 표지
DOI QR코드

DOI QR Code

Pineal and Suprasellar Germinoma Cooccurence with Vertebra Plana: A Case Report

  • Toosi, Farrokh Seilanian (Department of Radiology, Faculty of Medicine, Mashhad University of Medical Sciences) ;
  • Aminzadeh, Behzad (Department of Radiology, Faculty of Medicine, Mashhad University of Medical Sciences) ;
  • Rad, Mohammad Faraji (Department of Neurosurgery, Mashhad University of Medical Sciences) ;
  • Nekooei, Sirous (Department of Radiology, Faculty of Medicine, Mashhad University of Medical Sciences) ;
  • Nahidi, Mahsa (Psychiatry and Behavioral Sciences Research Center, Mashhad University of Medical Sciences) ;
  • Keykhosravi, Ehsan (Department of Neurosurgery, Mashhad University of Medical Sciences)
  • Received : 2018.03.24
  • Accepted : 2018.08.06
  • Published : 2018.10.31
⟨ Previous Next ⟩

Abstract

Germinoma is the most common type of intracranial germ cell tumors (GCTs). Pineal gland and suprasellar region are the most frequent sites of central nervous system (CNS) involvement. Intracranial masses caused by Langerhans cell histiocytosis (LCH) mimics features of CNS GCTs. LCH frequently involve spine and is the most common cause of vertebra plana in children. A 15-year-old boy presented with progressing symptoms of polydipsia, polyuria, general headache, nausea and severe back pain. Brain MRI showed brain tumor with simultaneous involvement of suprasellar region and pineal gland. An excisional biopsy of suprasellar mass was done. The pathologic assessment confirmed the diagnosis of germinoma. Patient's treatment continued accordingly. A spine MRI, done due to persistent backache, showed a vertebra plana. We reevaluated the primary diagnosis suspecting LCH. Germinoma of CNS was confirmed and a biopsy of vertebral lesion resulted in hemangioma. Thus we report a case of CNS germinoma with co-occurrence of vertebra plana. We emphasized the importance of histopathologic diagnosis of pineal/suprasellar masses and primary investigation of other CNS regions including spine for possible metastasis or comorbidities.

Keywords

References

  1. Jennings MT, Gelman R, Hochberg F. Intracranial germ-cell tumors: natural history and pathogenesis. J Neurosurg 1985;63:155-67. https://doi.org/10.3171/jns.1985.63.2.0155
  2. Cuccia V, Galarza M. Pure pineal germinomas: analysis of gender incidence. Acta Neurochir (Wien) 2006;148:865-71; discussion 871. https://doi.org/10.1007/s00701-006-0846-x
  3. Echevarria ME, Fangusaro J, Goldman S. Pediatric central nervous system germ cell tumors: a review. Oncologist 2008;13:690-9. https://doi.org/10.1634/theoncologist.2008-0037
  4. Cuccia V, Alderete D. Suprasellar/pineal bifocal germ cell tumors. Childs Nerv Syst 2010;26:1043-9. https://doi.org/10.1007/s00381-010-1120-3
  5. Freda PU, Post KD. Differential diagnosis of sellar masses. Endocrinol Metab Clin North Am 1999;28:81-117. https://doi.org/10.1016/S0889-8529(05)70058-X
  6. Smirniotopoulos JG, Rushing EJ, Mena H. Pineal region masses: differential diagnosis. Radiographics 1992;12:577-96. https://doi.org/10.1148/radiographics.12.3.1609147
  7. Yoon JY, Park BK, Yoo H, et al. A case of langerhans cell histiocytosis manifested as a suprasellar mass. Brain Tumor Res Treat 2016;4:26-9. https://doi.org/10.14791/btrt.2016.4.1.26
  8. Chaudhary V, Bano S, Aggarwal R, et al. Neuroimaging of Langerhans cell histiocytosis: a radiological review. Jpn J Radiol 2013;31:786-96. https://doi.org/10.1007/s11604-013-0254-0
  9. Packer RJ, Cohen BH, Cooney K. Intracranial germ cell tumors. Oncologist 2000;5:312-20. https://doi.org/10.1634/theoncologist.2000-0312
  10. McCarthy BJ, Shibui S, Kayama T, et al. Primary CNS germ cell tumors in Japan and the United States: an analysis of 4 tumor registries. Neuro Oncol 2012;14:1194-200. https://doi.org/10.1093/neuonc/nos155
  11. Robertson PL. CNS germ cell tumors: a clinical review and future directions. Future Neurology 2016;11:47-62. https://doi.org/10.2217/fnl.16.2
  12. Morgenstern PF, Souweidane MM. Pineal region tumors: simultaneous endoscopic third ventriculostomy and tumor biopsy. World Neurosurg 2013;79(2 Suppl):S18.e9-13. https://doi.org/10.1016/j.wneu.2012.02.020
  13. Bowzyk Al-Naeeb A, Murray M, Horan G, et al. Current management of intracranial germ cell tumours. Clin Oncol (R Coll Radiol) 2018;30:204-14. https://doi.org/10.1016/j.clon.2018.01.009
  14. Shibamoto Y, Takemoto S. Central nervous system germinoma. In: Mahajan A, Paulino A, editors. Radiation oncology for pediatric CNS tumors. Cham, Switzerland: Springer;2018. p.263-74.
  15. Huang WD, Yang XH, Wu ZP, et al. Langerhans cell histiocytosis of spine: a comparative study of clinical, imaging features, and diagnosis in children, adolescents, and adults. Spine J 2013;13:1108-17. https://doi.org/10.1016/j.spinee.2013.03.013
  16. Quinn SF. Vertebral Hemangioma. MRI Web Clinic 2006 (at http://radsource.us/vertebral-hemangioma/).
  17. Grossman R, Yousem D. Nondegenerative diseases of the spine. Neuroradiology. 3d ed. Philadelphia: Mosby;2003. p.827-8.
  18. Fox MW, Onofrio BM. The natural history and management of symptomatic and asymptomatic vertebral hemangiomas. J Neurosurg 1993;78:36-45. https://doi.org/10.3171/jns.1993.78.1.0036
  19. Johnson DE, Appelt G, Samuels ML, Luna M. Metastases from testicular carcinoma. Study of 78 autopsied cases. Urology 1976;8:234-9. https://doi.org/10.1016/0090-4295(76)90374-5

Cited by

  1. Pituitary Stalk Enlargement in Adults vol.110, pp.9, 2018, https://doi.org/10.1159/000506641
  2. Pineal Gland Tumors: A Review vol.13, pp.7, 2021, https://doi.org/10.3390/cancers13071547