Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Oct 6, 2020; 8(19): 4558-4564
Published online Oct 6, 2020. doi: 10.12998/wjcc.v8.i19.4558
Germinomas of the basal ganglia and thalamus: Four case reports
Zhen-Chao Huang, Qing Dong, En-Peng Song, Zhi-Jie Chen, Jin-Hua Zhang, Bo Hou, Zheng-Qi Lu, Feng Qin
Zhen-Chao Huang, En-Peng Song, Zhi-Jie Chen, Jin-Hua Zhang, Bo Hou, Feng Qin, Department of Neurosurgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, Guangdong Province, China
Qing Dong, Zheng-Qi Lu, Department of Neurology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, Guangdong Province, China
Author contributions: Huang ZC and Qin F were the patients’ neurosurgeons; Dong Q prepared the manuscript; Song EP, Chen ZJ, Zhang JH and Hou B reviewed the literature and contributed to manuscript drafting; Lu ZQ and Qin F were responsible for revision of the manuscript for important intellectual content.
Supported by The Third Affiliated Hospital of Sun Yat-Sen University, Clinical Research Program, No. YHJH201907.
Informed consent statement: Written informed consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Feng Qin, MD, Chief Doctor, Neurosurgeon, Department of Neurosurgery, The Third Affiliated Hospital of Sun Yat-Sen University, No. 600 Tianhe Road, Guangzhou 510630, Guangdong Province, China. qinfeng2@mail.sysu.edu.cn
Received: June 1, 2020
Peer-review started: June 1, 2020
First decision: July 25, 2020
Revised: July 29, 2020
Accepted: August 29, 2020
Article in press: August 29, 2020
Published online: October 6, 2020
Processing time: 118 Days and 13.7 Hours
Abstract
BACKGROUND

The early diagnosis of basal ganglia and thalamus germinomas is often difficult due to the absence of elevated tumor markers, and atypical clinical symptoms and neuroimaging features.

CASE SUMMARY

Four male children aged 8 to 15 years were diagnosed with germinomas in the basal ganglia and thalamus by stereotactic biopsy from 2017 to 2019. All patients developed hemiplegia except patient 4 who also had cognitive decline, speech disturbance, nocturnal enuresis, polydipsia, polyuria, precocious puberty and abnormalities of thermoregulation. All four cases were alpha-fetoprotein and beta-human chorionic gonadotrophin (β-HCG) negative except patient 3 who had slightly elevated β-HCG in cerebrospinal fluid (CSF). No malignant cells were detected in the patients’ CSF. Brain magnetic resonance imaging findings were diverse in these patients with the exception of the unique and common characteristics of ipsilateral hemisphere atrophy, especially in the cerebral peduncle. All patients were diagnosed with germinomas of the basal ganglia and thalamus by stereotactic brain biopsy.

CONCLUSION

Stereotactic brain biopsy is necessary to confirm the diagnosis of ectopic germinomas. Serial neuroimaging studies can not only differentiate disease but also determine the biopsy site.

Keywords: Intracranial germinoma; Stereotactic brain biopsy; Basal ganglia; Thalamus; Tumor marker; Case report

Core Tip: Basal ganglia and thalamus germinomas are rare and early diagnosis of these tumors is usually difficult due to insidious onset, absence of elevated tumor markers, and subtle and atypical neuroimaging features. The definite diagnosis of these ectopic germinomas depends on histopathological examination. In this report, we describe four intractable cases whose histopathological diagnoses were germinomas in the basal ganglia and thalamus. Ipsilateral hemiatrophy, which was a common characteristic on neuroimaging of germinomas in the basal ganglia and thalamus, may be an important feature in differentiating these lesions from other intracranial tumors.