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Suprasellar germinoma and late perioptic seeding.
L S Pereira1, A J Green, T N Hwang
1Department of Ophthalmology, University of California, San Francisco, CA 94143, USA.
European Journal of Ophthalmology
|January 19, 2008
Summary
Late optic nerve seeding from a suprasellar germinoma occurred 12 years after treatment. This case highlights the need for lifelong surveillance in germinoma survivors.
Area of Science:
- Neuro-oncology
- Ophthalmology
- Radiation Oncology
Background:
- Suprasellar germinomas are rare tumors typically treated with surgery and radiation.
- Long-term surveillance is crucial for detecting late recurrences or metastases.
Observation:
- A 34-year-old woman presented with unilateral vision loss 12 years after treatment for a suprasellar germinoma.
- Examination revealed decreased visual acuity, a relative afferent pupillary defect, and optic nerve pallor in the affected eye.
- MRI showed enhancement of both optic nerves and cranial nerves V and VII, with elevated tumor markers.
Findings:
- The patient was diagnosed with metastatic germinoma manifesting as optic nerve and cranial nerve seeding.
- Treatment with chemotherapy (VIP regimen) resulted in complete visual recovery and radiographic improvement.
- Cerebrospinal fluid cytology normalized after treatment.
Implications:
- Perioptic subarachnoid seeding can occur more than a decade after successful germinoma treatment.
- This case underscores the importance of lifelong oncologic and ophthalmologic surveillance for germinoma survivors.
- Early detection and prompt treatment are vital for preserving vision and neurological function.
