An intrasellar germinoma with normal tumor marker concentrations mimicking primary lymphocytic hypophysitis

Abstract

Intracranial germinomas (GE) are malignant neoplasms most commonly found in the suprasellar region, which may cause anterior and particularly posterior pituitary hormone deficits with central diabetes insipidus (DI). Differential diagnosis of pituitary stalk thickening includes granulomatous, inflammatory, infectious, and neoplastic lesions. Although careful analysis of clinical, laboratory, and imaging findings may facilitate the diagnosis, transsphenoidal biopsy is indicated to confirm the disease, as the correct diagnosis directs the appropriate treatment.

Pituitary stalk thickening: the role of an innovative MRI imaging analysis which may assist in determining clinical management

“…The management of disorders associated specifically with abnormalities of the pituitary stalk is highly problematic, and it remains unclear as to how and when surgical intervention is required, given that surgery can be associated with significant morbidity. Magnetic resonance imaging (MRI) has proved to be an essential tool in the evaluation of intracranial pathology and of the majority of lesions affecting the hypothalamo-pituitary region (1,2,3,4,5,6), but its role in determining when surgery is appropriate in this situation is controversial (7,8).…”

A Unique Case of Central Hypopituitarism and Central Diabetes Insipidus Caused By Diffuse Large B-Cell Lymphoma

“…Thus, the posterior pituitary has a larger area of contact with the adjacent dura. Central DI is therefore the most common symptom associated with metastatic pituitary disease (12,19,20). The conclusions of He et al (19) were also supported by the discussion by Yang et al (21) of the lymphomatous pituitary infiltrative processes described in the literature: 57.9% of cases resulted in DI, whereas 26.3% only had anterior pituitary hypofunction, and 15.8% had concurrent anterior and posterior dysfunction.…”

“…Hamilton et al (9) classified pituitary infundibular lesions by categories of tumor, inflammatory/ infectious, and congenital, of which, in their study population, 37% were malignant tumor, 33% were congenital, and 30% were inflammatory. Search of the literature yielded diverse case reports of central DI that occur secondary to sarcoidosis (10), granulomatosis with polyangiitis (11), Sjögren syndrome, Langerhans cell histiocytosis, systemic lupus erythematosus, as well as malignancy, with the most common being germinomas (12,13), lymphoma (14-16), and metastases from solid tumors (most commonly breast and lung) (17).…”

Perifocal Inflammatory Reaction with Volume Fluctuation Caused by Diagnostic Radiation-Induced Regression in Germinoma Makes Histological Diagnosis Difficult despite Its Disappearance following Treatment: A Significant Pitfall and Countermeasures to It

“…Previously, although careful analysis of clinical, laboratory, and imaging find- ings may facilitate the diagnosis, transsphenoidal biopsy is necessary to confirm the disease, because the correct diagnosis directs the appropriate treatment [11,36] . In endoscopic biopsy, a granulomatous tissue response in germinoma is a diagnostic pitfall, although rare [13] .…”

“…Some case reports of granulomatous neurohypophyseal germinoma are available [2,3] as well as germinoma masquerading as lymphocytic hypophysitis [4][5][6][7][8][9][10][11] . A granulomatous inflammation/ reaction can mislead histopathological diagnosis if biopsy shows mainly granulomatous tissues [1,2,12,13] .…”