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Case Reports in Endocrinology
Volume 2014, Article ID 936937, 5 pages
http://dx.doi.org/10.1155/2014/936937
Case Report

Germinoma with Involvement of Midline and Off-Midline Intracranial Structures

1Division of Endocrinology, Metabolism, Nutrition and Diabetes, 1828 Caseros Avenue, 1152 Buenos Aires, Argentina
2Department of Neurosurgery, British Hospital, 1828 Caseros Avenue, 1152 Buenos Aires, Argentina

Received 4 December 2013; Accepted 24 December 2013; Published 9 February 2014

Academic Editors: M. A. Boyanov and W. V. Moore

Copyright © 2014 Monica Graciela Loto et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Germinomas are malignant intracranial germ tumors, usually found in suprasellar regions. Less than 10% are localized in off-middle structures, and synchronous involvement of both structures has only exceptionally been published. A case of an 18-year-old male patient with progressive right-sided hemiparesis and panhypopituitarism was reviewed. Brain MRI showed a solid mass involving pituitary and hypothalamus with thickening of pituitary stalk, high intensity lesions on T2-weighted imaging in left internal capsule, caudate nucleus, globus pallidus, and mild atrophy of the left internal capsule and cerebral peduncle. Nonadenomatous lesions were considered in the differential diagnosis. Alfa-fetoprotein (AFP) levels were negative in both serum and cerebrospinal fluid (CSF), while β-human chorionic gonadotrophin (β-HCG) levels were slightly increased in CSF. A transsphenoidal biopsy identified a germinoma. Four cycles of chemotherapy with bleomicine, etoposide, and cysplatin were given, followed by radiotherapy, but patients died due to a recidiva. Conclusion. Germinoma must be considered in patients with insipidus diabetes with a sellar mass with thickening of pituitary stalk; and ectopic germinoma must be suspected in patients with slowly progressive hemiparesis with cerebral hemiatrophy. Even with a rare condition, colocalization of midline and off-midline germinoma must be suspected in the presence of these typical signs of both localizations.