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Suprasellar Germinoma

  • An-Guor Wang
Chapter

Abstract

A 14-year-old girl reported experiencing blurred vision beginning 2 months and 1 month ago in the left and right eye, respectively. She was examined at two local hospitals before she was referred to us under the impression of optic neuropathy. Her corrected visual acuity was 2/60 in the right eye and light perception only in the left. She could identify one plate in the right eye and zero plate in the left eye with the Ishihara color test. Anterior segment was normal OU. Fundoscopic examination revealed optic atrophy in both eyes (Fig. 44.1). Peripapillary nerve fibers and macular ganglion cell complexes were near totally lost in both eyes. Central scotoma with peripheral constriction was noted in the right eye, while the visual field in the left eye was totally lost (Fig. 44.2). An MRI showed a suprasellar lesion with a cystic component that was heterogeneously enhanced (Fig. 44.3). The patient underwent a craniotomy for the removal of the suprasellar tumor 1 week later. The pathologic report indicated germinoma. Peripheral blood testing for AFP, beta HCG, and ACTH was normal. She received extended focal radiation of 44 Gy. In addition, cortisol and thyroxine were given as postsurgical replacement treatments. Two months later, her vision recovered to 6/60 in the right eye, but the left vision remained as light perception.

References

  1. 1.
    Penn A, Jenney MEM, Nicholson JC. Germ cell tumours in children and adolescents. Paediatrics Child Health. 2014;24(4):148–54.CrossRefGoogle Scholar
  2. 2.
    Nagasawa DT, Lagman C, Sun M, Yew A, Chung LK, Lee SJ, Bui TT, Ooi YC, Robison RA, Zada G, Yang I. Pineal germ cell tumors: two cases with review of histopathologies and biomarkers. J Clin Neurosci. 2017;38:23–31.CrossRefPubMedGoogle Scholar
  3. 3.
    Hoffman HJ, Otsubo H, Hendrick EB, Humphreys RP, Drake JM, Becker LE, Greenberg M, Jenkin D. Intracranial germ-cell tumors in children. J Neurosurg. 1991;74(4):545–51.CrossRefPubMedGoogle Scholar
  4. 4.
    Frappaz D, Pedone C, Thiesse P, Szathmari A, Conter CF, Mottolese C, Carrie C. Visual complaints in intracranial germinomas. Pediatr Blood Cancer. 2017;64(10).  https://doi.org/10.1002/pbc.26543. CrossRefGoogle Scholar
  5. 5.
    Wong AME. Eye movement disorders. Oxford: Oxford University Press; 2008. p. 140–1.Google Scholar
  6. 6.
    Kilgore DP, Strother CM, Starshak RJ, Haughton VM. Pineal germinoma: MR imaging. Radiology. 1986;158(2):4358.CrossRefGoogle Scholar
  7. 7.
    Liang L, Korogi Y, Sugahara T, Ikushima I, Shigematsu Y, Okuda T, Takahashi M, Kochi M, Ushio Y. MRI of intracranial germ cell tumours. Neuroradiology. 2002;44(5):3828.CrossRefGoogle Scholar
  8. 8.
    Wolden SL, Wara WM, Larson DA, et al. Radiation therapy for primary intracranial germ-cell tumors. Int J Radiat Oncol Biol Phys. 1995;32:943–9.CrossRefPubMedGoogle Scholar
  9. 9.
    Haas-Kogan DA, Missett BT, Wara WM, et al. Radiation therapy for intracranial germ cell tumors. Int J Radiat Oncol Biol Phys. 2003;56:511–8.CrossRefPubMedGoogle Scholar
  10. 10.
    Jensen AW, Laack NN, Buckner JC, et al. Long-term follow-up of dose-adapted and reduced-field radiotherapy with or without chemotherapy for central nervous system germinoma. Int J Radiat Oncol Biol Phys. 2010;77:1449–56.CrossRefPubMedGoogle Scholar
  11. 11.
    Calaminus G, Bamberg M, Jurgens H, et al. Impact of surgery, chemotherapy and irradiation on long term outcome of intracranial malignant nongerminomatous germ cell tumors: results of the German Cooperative Trial MAKEI 89. Klin Padiatr. 2004;216:141–9.CrossRefPubMedGoogle Scholar
  12. 12.
    Kochi M, Itoyama Y, Shiraishi S, et al. Successful treatment of intracranial nongerminomatous malignant germ cell tumors by administering neoadjuvant chemotherapy and radiotherapy before excision of residual tumors. J Neurosurg. 2003;99:106–14.CrossRefPubMedGoogle Scholar
  13. 13.
    Balmaceda C, Finlay J. Current advances in the diagnosis and management of intracranial germ cell tumors. Curr Neurol Neurosci Rep. 2004;4:253–62.CrossRefPubMedGoogle Scholar
  14. 14.
    Matsutani M, Sano K, Takakura K, et al. Primary intracranial germ cell tumors: a clinical analysis of 153 histologically verified cases. J Neurosurg. 1997;86:446–55.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2018

Authors and Affiliations

  • An-Guor Wang
    • 1
  1. 1.Department of OphthalmologyTaipei Veterans General Hospital, National Yang-Ming University School of Medicine, Yun-San Ophthalmology Education Research FoundationTaipeiTaiwan

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