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Primary human chorionic gonadotropin secreting germinoma of the corpus callosum.

Chuan Aaron FS, Dawn CQ, Kenneth CT, Hoe NW, Yen SS, Chee Kian T - Surg Neurol Int (2013)

Bottom Line: Though known to arise from midline structures in the central nervous system (CNS), occurrence within the corpus callosum is exceedingly rare.We present a rare case of secreting primary intracranial germinoma with extensive intraventricular metastasis presenting as a multi-cystic butterfly lesion in the genu of the corpus callosum in a young boy.Intracranial germ cell tumors must be considered for any multi-cystic lesion arising from midline structures in the CNS in the preadult population.

View Article: PubMed Central - PubMed

Affiliation: Department of Medical Oncology, National Cancer Centre, 11 Hospital Drive, Singapore 169610.

ABSTRACT

Background: Primary intracranial germinomas are a rare subset of intracranial tumors derived from mis-incorporated germ cells within the folding neural plate during embryogenesis. Though known to arise from midline structures in the central nervous system (CNS), occurrence within the corpus callosum is exceedingly rare.

Case description: We present a rare case of secreting primary intracranial germinoma with extensive intraventricular metastasis presenting as a multi-cystic butterfly lesion in the genu of the corpus callosum in a young boy.

Conclusion: Intracranial germ cell tumors must be considered for any multi-cystic lesion arising from midline structures in the CNS in the preadult population.

No MeSH data available.


Related in: MedlinePlus

Noncontrasted MRI of tumor in corpus callosum with intraventricular involvement
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Figure 2: Noncontrasted MRI of tumor in corpus callosum with intraventricular involvement

Mentions: Initial blood investigations revealed a white blood cell count of 6.92×109/L and a C-reactive protein level of <5.0 mg/L. Serum alphafetoprotein (AFP) and human chorionic gonadotropin (b-HCG) were not elevated. Other abnormal serum biochemical parameters included free thyroxine (FT4) of 9.4 pmol/L, thyroid stimulating hormone (TSH) of 3.92 mIU/L, follicular stimulating hormone of <0.1 IU/L, luteinizing hormone of <0.07 IU/L, sodium of 155 mmol/L and serum osmolality of 323 mOSm/kg. Cerebrospinal fluid (CSF) AFP levels were normal but CSF b-HCG levels, however, were markedly elevated at 1837.01 IU/L. Contrasted computer tomographic (CT) imaging revealed a heterogenous 4 cm mass centered in the genu of the corpus callosum, filling the anterior aspect of the third ventricle and spreading along the margins of both frontal horns, causing obstruction of the Foramina of Monro and hydrocephalus. Thickening and enhancement was also noted along the margins of both lateral ventricles and a 1.3×0.9 cm enhancing nodule visualised in the 4th ventricle [Figure 1]. Further workup also revealed that the patient was suffering from central diabetes insipidus as well as panhypopituitarism. After neurosurgical team review, the diagnosis of GCT with extensive intraventricular CSF seeding was considered. Subsequent magnetic resonance imaging (MRI) brain reported multiple intraventricular contiguous and noncontiguous cystic masses with extension superiorly into the frontal horns, the genu of the corpus callosum and the septum pellucidum, inferiorly into the suprasellar region, as well as laterally into the right temporal horn [Figure 2]. Small cystic foci were also noted in the vicinity of the pineal gland. MRI attempted at this juncture was not augmented with contrasted medium due to acute kidney injury from excessive diuresis precipitated by central diabetes insipidus. No spinal drop metastases were visualized on MRI.


Primary human chorionic gonadotropin secreting germinoma of the corpus callosum.

Chuan Aaron FS, Dawn CQ, Kenneth CT, Hoe NW, Yen SS, Chee Kian T - Surg Neurol Int (2013)

Noncontrasted MRI of tumor in corpus callosum with intraventricular involvement
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3815051&req=5

Figure 2: Noncontrasted MRI of tumor in corpus callosum with intraventricular involvement
Mentions: Initial blood investigations revealed a white blood cell count of 6.92×109/L and a C-reactive protein level of <5.0 mg/L. Serum alphafetoprotein (AFP) and human chorionic gonadotropin (b-HCG) were not elevated. Other abnormal serum biochemical parameters included free thyroxine (FT4) of 9.4 pmol/L, thyroid stimulating hormone (TSH) of 3.92 mIU/L, follicular stimulating hormone of <0.1 IU/L, luteinizing hormone of <0.07 IU/L, sodium of 155 mmol/L and serum osmolality of 323 mOSm/kg. Cerebrospinal fluid (CSF) AFP levels were normal but CSF b-HCG levels, however, were markedly elevated at 1837.01 IU/L. Contrasted computer tomographic (CT) imaging revealed a heterogenous 4 cm mass centered in the genu of the corpus callosum, filling the anterior aspect of the third ventricle and spreading along the margins of both frontal horns, causing obstruction of the Foramina of Monro and hydrocephalus. Thickening and enhancement was also noted along the margins of both lateral ventricles and a 1.3×0.9 cm enhancing nodule visualised in the 4th ventricle [Figure 1]. Further workup also revealed that the patient was suffering from central diabetes insipidus as well as panhypopituitarism. After neurosurgical team review, the diagnosis of GCT with extensive intraventricular CSF seeding was considered. Subsequent magnetic resonance imaging (MRI) brain reported multiple intraventricular contiguous and noncontiguous cystic masses with extension superiorly into the frontal horns, the genu of the corpus callosum and the septum pellucidum, inferiorly into the suprasellar region, as well as laterally into the right temporal horn [Figure 2]. Small cystic foci were also noted in the vicinity of the pineal gland. MRI attempted at this juncture was not augmented with contrasted medium due to acute kidney injury from excessive diuresis precipitated by central diabetes insipidus. No spinal drop metastases were visualized on MRI.

Bottom Line: Though known to arise from midline structures in the central nervous system (CNS), occurrence within the corpus callosum is exceedingly rare.We present a rare case of secreting primary intracranial germinoma with extensive intraventricular metastasis presenting as a multi-cystic butterfly lesion in the genu of the corpus callosum in a young boy.Intracranial germ cell tumors must be considered for any multi-cystic lesion arising from midline structures in the CNS in the preadult population.

View Article: PubMed Central - PubMed

Affiliation: Department of Medical Oncology, National Cancer Centre, 11 Hospital Drive, Singapore 169610.

ABSTRACT

Background: Primary intracranial germinomas are a rare subset of intracranial tumors derived from mis-incorporated germ cells within the folding neural plate during embryogenesis. Though known to arise from midline structures in the central nervous system (CNS), occurrence within the corpus callosum is exceedingly rare.

Case description: We present a rare case of secreting primary intracranial germinoma with extensive intraventricular metastasis presenting as a multi-cystic butterfly lesion in the genu of the corpus callosum in a young boy.

Conclusion: Intracranial germ cell tumors must be considered for any multi-cystic lesion arising from midline structures in the CNS in the preadult population.

No MeSH data available.


Related in: MedlinePlus