Primary spinal conus medullaris germinoma

Area of Science:

• Neuro-oncology
• Spinal Cord Tumors
• Neurosurgery

Background:

• Intramedullary spinal cord tumors are rare, often presenting with progressive neurological deficits.
• Germinomas are germ cell tumors that can occur in the central nervous system, including the spinal cord.
• Diagnosis can be challenging, requiring a combination of imaging and biochemical markers.

Purpose of the Study:

• To report a case of a young woman with an intramedullary spinal cord germinoma.
• To discuss the diagnostic and therapeutic challenges associated with spinal germinomas.
• To highlight the potential for recurrence despite multimodal treatment.

Main Methods:

• Clinical presentation of progressive low back pain, leg weakness, and sphincter dysfunction.
• Magnetic Resonance Imaging (MRI) revealing a 5 × 1.5 cm intramedullary tumor at the T12-L2 level.
• Surgical excision of the tumor and histopathological confirmation of germinoma.
• Postoperative assessment including MRI and localized radiation therapy.

Main Results:

• Elevated preoperative beta-human chorionic gonadotropin (β-hCG) levels were detected.
• Surgical excision confirmed the diagnosis of germinoma.
• Postoperative MRI showed no residual or additional lesions initially.
• Tumor recurrence was observed 10 months after initial treatment.

Conclusions:

• Spinal cord germinomas, though rare, should be considered in young adults with relevant symptoms and elevated β-hCG.
• Multimodal treatment including surgery and radiation may be effective, but recurrence is possible.
• Long-term surveillance is crucial for patients treated for spinal cord germinomas.