Kumar Virang, Mahdi Eman, Moore Nicholas, Vorona Gregory, Mishra Chakradhar, Jones Kathryn, Urbine Jacqueline
Department of Radiology, Virginia Commonwealth University, 1250 E Marshall St, Richmond, VA 23298, USA.
Radiol Case Rep. 2022 Sep 27;17(12):4537-4541. doi: 10.1016/j.radcr.2022.08.102. eCollection 2022 Dec.
Central nervous system germ cell tumors are rare lesions that are more frequently seen in the pediatric age group. Intracranial germinomas are a type of these germ cell tumors and commonly arise in the pineal region, suprasellar region, or less frequently at both areas (bifocal). Common features of this tumor depend on the location of the lesion(s) and include Parinaud's syndrome, obstructive hydrocephalus, diabetes insipidus, panhypopituitarism, strabismus, and visual acuity defects. We report a case of bifocal pineal and suprasellar germinoma with posterior fossa metastases in a 15-year-old male patient. The involvement of the third ventricular floor and nonthickened inferior pituitary stalk of the suprasellar lesion suggest that it is a metastasis of a primary pineal lesion rather than a dual-primary. This distinction, with the presence of posterior fossa metastases, favors the use of more aggressive treatment with combination radiation therapy and chemotherapy for a better outcome.
中枢神经系统生殖细胞肿瘤是罕见的病变，在儿童年龄组中更常见。颅内生殖细胞瘤是这些生殖细胞肿瘤的一种类型，通常发生在松果体区、鞍上区，或较少见地同时发生在这两个区域（双灶性）。这种肿瘤的常见特征取决于病变的位置，包括帕里诺德综合征、梗阻性脑积水、尿崩症、全垂体功能减退、斜视和视力缺陷。我们报告一例15岁男性患者，患有双灶性松果体和鞍上生殖细胞瘤并伴有后颅窝转移。鞍上病变累及第三脑室底部和未增厚的垂体柄下部，提示这是原发性松果体病变的转移，而非双原发。这种区别，加上存在后颅窝转移，有利于采用更积极的联合放射治疗和化疗，以获得更好的治疗效果。
