Elsevier

Pediatric Neurology

Volume 20, Issue 4, April 1999, Pages 312-314
Pediatric Neurology

Case Reports
Basal ganglia germinoma with progressive cerebral hemiatrophy

https://doi.org/10.1016/S0887-8994(98)00161-1Get rights and content

Abstract

The authors describe a 7-year-old Chinese-American female with a germinoma of the basal ganglia who presented with progressive hemiparesis and cerebral hemiatrophy. The additional finding of markedly elevated antiphospholipid antibodies suggests the possibility of an autoimmune pathogenesis for the progressive cerebral atrophy, as well as the later development of cognitive decline, tics, and obsessive-compulsive behaviors.

Introduction

Germinomas, which are believed to arise from the primordial germ cells, are the least malignant and most common of all germ cell tumors, a category that also includes embryonal cell carcinomas, endodermal sinus tumors, choriocarcinomas, and teratomas [1]. Germinomas represent 0.5-2.1% of all intracranial tumors and have a peak incidence in the latter half of the second decade [2]. Most of these tumors are found at the midline in the pineal or suprasellar regions. The authors present a case of an off-midline germinoma with progressive cerebral hemiatrophy.

Section snippets

Case report

A 7-year-old, previously healthy and developmentally normal, right-handed Chinese-American female developed a slowly progressive right-sided hemiparesis. Two months after the onset of these symptoms, computed tomography (not shown) revealed mineralization of the left globus palidus and expansion of the frontal horn of the left lateral ventricle, indicating tissue loss. Magnetic resonance imaging (MRI) revealed volume loss of the left caudate head and abnormal T2-weighted signal within the

Discussion

Although central nervous system (CNS) germinomas usually occur at the midline, several reports from Asian countries have found that up to 14% of these tumors arise within the basal ganglia or thalamus [2], [3], a geographic bias consistent with the Chinese background of the authors’ patient. A recent review of 42 cases also revealed a strong sex and age bias, with a male/female ratio of 20:1, with all patients between 6 and 20 years of age [2]. As was the case with the authors’ patient, these

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