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Intracranial bifocal germinoma.

Meriem Haloua1, Nizar El Bouardi1, Mohamed Hbibi2

  • 1Department of Radiology - CHU Hassan II. Faculty of Medicine and Pharmacy, Sidi Mohamed BenAbdellah University. Fez, Morocco.

Radiology Case Reports
|June 27, 2022
PubMed
Summary

This case study highlights a rare bifocal intracranial germinoma in a 10-year-old child. Diagnosis involved imaging and human chorionic gonadotrophin markers, confirming a challenging pediatric brain tumor.

Keywords:
Bifocal germinomaEpiphysis intracranial germ cell tumourHypophysisPineal tumorSuprasellar tumor

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Area of Science:

  • Pediatric Oncology
  • Neuro-oncology
  • Endocrinology

Background:

  • Primary intracranial germ cell tumors (GCTs) are rare, predominantly affecting pediatric and young adult populations.
  • Germinomas represent the most frequent subtype of intracranial GCTs.
  • Early diagnosis and management are crucial due to potential long-term sequelae.

Observation:

  • A 10-year-old child presented with visual disturbances, fatigue, polyuria, polydipsia, and gait abnormalities.
  • Biological workup revealed hypocortisolemia and central diabetes insipidus.
  • Neuroimaging identified a bifocal process in the suprasellar and pineal regions.

Findings:

  • The clinical presentation, imaging findings, and elevated human chorionic gonadotrophin (hCG) in cerebrospinal fluid supported a diagnosis of bifocal germinoma.
  • Biopsy confirmed the diagnosis of a bifocal germ cell tumor.
  • The patient was admitted to the pediatric oncology department for further management.

Implications:

  • Diagnosis of intracranial GCTs relies on a combination of advanced imaging, tumor marker analysis (including hCG), and histopathological confirmation.
  • Treatment typically involves radiation therapy, chemotherapy, and potentially surgery for residual tumor, though surgical resection can be challenging due to tumor location.
  • This case underscores the importance of considering rare diagnoses in pediatric patients with complex neurological and endocrine symptoms.