Steidl Eike, Zschernack Valentina, Träber Frank, Schäfer Niklas
Department of Radiology, University Hospital Bonn, Germany.
Department of Neuropathology, University Hospital Bonn, Germany.
Oxf Med Case Reports. 2019 Feb 25;2019(2):omz001. doi: 10.1093/omcr/omz001. eCollection 2019 Feb.
CNS germinoma is a malignant germ cell tumor with a high potential for curative treatment. In MRI it mainly appears as contrast enhancing mass in the midline structures of the brain but it can also occur atypically located in the basal ganglia. We present the case of a 21-year-old patient suffering from psychiatric symptoms and a mild, right-sided hemiparesis. A MRI scan solely showed diffuse T2/FLAIR hyperintensity and mild atrophy around the left basal ganglia. As excessive diagnostics remained insignificant, H-MR-spectroscopy was performed. Considering the previous diagnostics, increased choline, decreased NAA and increased Myoinositol suggested a malignant disease. Consequently, brain biopsy was performed, revealing a germinoma. In comparable, published cases a lack of evidence for a neoplastic disease usually leads to a severely delayed diagnosis. Our report shows for the first time, that this evidence can be obtained early with MR-spectroscopy and discusses the possibility of specific metabolic patterns.
中枢神经系统生殖细胞瘤是一种恶性生殖细胞肿瘤，具有很高的治愈潜力。在磁共振成像（MRI）中，它主要表现为脑中线结构的强化肿块，但也可能非典型地发生在基底神经节。我们报告一例21岁患者，有精神症状和轻度右侧偏瘫。MRI扫描仅显示左侧基底神经节周围弥漫性T2/液体衰减反转恢复序列（FLAIR）高信号和轻度萎缩。由于进一步检查无明显异常，遂进行了氢质子磁共振波谱（H-MR-spectroscopy）检查。鉴于之前的检查结果，胆碱升高、N-乙酰天门冬氨酸（NAA）降低和肌醇升高提示为恶性疾病。因此，进行了脑活检，结果显示为生殖细胞瘤。在类似的已发表病例中，缺乏肿瘤性疾病的证据通常会导致诊断严重延迟。我们的报告首次表明，通过磁共振波谱可以早期获得这种证据，并讨论了特定代谢模式的可能性。
