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Intracranial mixed germ cell tumor mimicking a meningioma: illustrative case
Flavio Hernández González1, Federico Chávez Peón Pérez1, Martín R De León Salazar1
1Neurosurgery Department, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico City, Mexico.
Background:
Germ cell tumors have a low incidence in the Hispanic population and most frequently present in pineal or suprasellar regions. Only a few cases have been reported with an initial image compatible with a meningioma-like appearance.
Observations:
A 24-year-old male with photopsias, headache, and left homonymous hemianopia presented with a right parieto-occipital extra-axial mass. MRI revealed a heterogeneous enhancing mass, with hemorrhagic zones and surrounding vasogenic edema. Surgery with a near-total resection was performed and an extra-axial lesion with infiltration of the deep venous system was found. Histopathological evaluation revealed a mixed germ cell tumor with a yolk sac tumor and immature teratoma. Postoperative investigation revealed elevated serum α-fetoprotein and pulmonary metastasis. Radiotherapy and chemotherapy followed surgical treatment.
Lessons:
Germ cell tumors can present as extra-axial dura-based lesions and should be suspected in young patients with imaging showing lesions with cystic or hemorrhagic components. Pulmonary metastases are infrequent but may be present. For successful treatment, chemotherapy and radiation therapy should always be considered. https://thejns.org/doi/10.3171/CASE25855.
Insights
Germ cell tumors, rare in Hispanics, can mimic meningiomas on imaging. This case highlights a mixed germ cell tumor presenting as an extra-axial lesion with pulmonary metastases, emphasizing the need for prompt diagnosis and multimodal treatment.
Area of Science:
- Neuro-oncology
- Pathology
- Radiology
Background:
- Germ cell tumors (GCTs) are uncommon in Hispanic populations, typically occurring in the pineal or suprasellar regions.
- Few GCT cases present with imaging suggestive of meningioma.
- Extra-axial GCTs are rare and challenging to diagnose preoperatively.
Purpose of the Study:
- To report a rare case of an extra-axial germ cell tumor mimicking meningioma.
- To discuss the diagnostic challenges and treatment strategies for such rare presentations.
- To highlight the importance of considering GCTs in young patients with atypical intracranial masses.
Main Methods:
- A 24-year-old male presented with visual disturbances and headache.
- MRI revealed a right parieto-occipital extra-axial mass with heterogeneous enhancement, hemorrhage, and edema.
- Surgical resection, histopathological analysis (mixed GCT: yolk sac tumor, immature teratoma), and adjuvant therapy (chemotherapy, radiotherapy) were performed.
Main Results:
- Histopathology confirmed a mixed germ cell tumor with yolk sac tumor and immature teratoma components.
- Elevated serum alpha-fetoprotein and pulmonary metastases were detected postoperatively.
- The tumor infiltrated the deep venous system, necessitating near-total resection.
Conclusions:
- Germ cell tumors can manifest as extra-axial dura-based lesions, particularly in young individuals.
- Imaging findings such as cystic or hemorrhagic components should raise suspicion for GCTs.
- Pulmonary metastases, though infrequent, can occur; multimodal treatment including chemotherapy and radiotherapy is crucial.
