Magnetic resonance imaging of neurohypophyseal germinomas

Fujisawa, Ichiro; Asato, Reinin; Okumura, Ryota; Nakano, Yoshihisa; Shibata, Toru; Hamanaka, D; Hashimoto, Takaji; Konishi, Junji

doi:10.1002/1097-0142(19910901)68:5<1009::aid-cncr2820680517>3.0.co;2-r

Cited by 60 publications

(27 citation statements)

References 27 publications

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“…Thanks to magnetic resonance imaging (MRI), an early diagnosis of pituitary stalk infiltration with lack of posterior pituitary hyperintensity is now possible (2)(3)(4)(5). In particular, the presence of an isolated thickened pituitary stalk is a frequent finding with evolution to either germinomas (1,9) or a self-limiting disease as in lymphocytic infundibuloneurohypophysitis (3). Diagnosis of the cause of central diabetes insipidus remains a challenge in many cases.…”

Section: Introductionmentioning

confidence: 99%

Evolution of childhood central diabetes insipidus into panhypopituitarism with a large hypothalamic mass: is 'lymphocytic infundibuloneurohypophysitis' in children a different entity?

Maghnie¹,

Genovese²,

Sommaruga³

et al. 1998

Eur J Endocrinol

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We report on a 15-year-old girl who had presented with acute onset central diabetes insipidus at the age of 8 years; this was followed by growth failure due to acquired growth hormone deficiency. Initial magnetic resonance imaging showed a uniformly enlarged pituitary stalk and absence of posterior pituitary hyperintensity. Frequent patient examination and magnetic resonance imaging gave unchanged results until after 5 years a large hypothalamic mass and panhypopituitarism were found. Dynamic magnetic resonance imaging documented hypothalamic-pituitary vasculopathy. Histopathological examination revealed perivascular inflammatory lymphoplasmic infiltrates with no granulomatosis or necrosis and negative staining for S-100 protein, suggesting autoimmuneinflammatory disease (lymphocytic infundibuloneurohypophysitis?). The response to glucocorticoid pulses (30 mg/kg per day for 3 days i.v.) was favorable, the hypothalamic mass being halved and partial anterior pituitary function recovery maintained for 2 years after the start of treatment. We suggest that long-term surveillance is needed for isolated and chronic thickening of the pituitary stalk and that dynamic magnetic resonance imaging can contribute to the demonstration of hypothalamic-pituitary vascular impairment associated with local vasculitis.

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Section: Introductionmentioning

confidence: 99%

Evolution of childhood central diabetes insipidus into panhypopituitarism with a large hypothalamic mass: is 'lymphocytic infundibuloneurohypophysitis' in children a different entity?

Maghnie¹,

Genovese²,

Sommaruga³

et al. 1998

Eur J Endocrinol

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“…3 Conversely, in germinomas, the PBS is noted to be absent in 100% of cases, whether the patient presents with DI or not. 9 Failure to demonstrate a PBS in the context of a sellar and suprasellar mass should therefore prompt the clinician to consider the possibility of a germinoma, as well as other diagnoses associated with this feature.…”

Section: Illustrative Case 4: Germinomamentioning

confidence: 99%

“…When DI was a presenting symptom of one of these conditions, the PBS was always absent. 7,9,12,15,17,18 In conditions in which the posterior pituitary is depleted of its vasopressin granules, the hyperintense T1 signal can also be lost. An absent PBS was observed in 32% of patients with uncontrolled diabetes mellitus 11 and in a patient with severe anorexia nervosa.…”

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confidence: 99%

Normal dimensions of the posterior pituitary bright spot on magnetic resonance imaging

Côté¹,

Salzman

Sorour³

et al. 2014

JNS

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A n area of T1 hyperintensity is normally observed in the posterior part of the sella turcica on MR images of the brain. This phenomenon, often referred to as the pituitary bright spot (PBS), is thought to result from the T1-shortening effect of stored vasopressin in the posterior lobe of the pituitary 1,12 and is observed in 100% of children 15,17 and in 52% to 100% of adults 5,6,8,19,22 without pituitary disease. The PBS may be absent in up to 48% of normal subjects, more often in older patients.5,23 Individual variations in the appearance of the PBS have been observed. Physiological conditions such as very young age, pregnancy, or lactation may result in an enlarged PBS. 2An abnormal PBS can also be seen in various pathological processes. Central diabetes insipidus (DI) results from low blood levels of vasopressin and may be primary or secondary to a number of causes. In primary central DI, the PBS has been found to be absent in 25% to 100% of cases. 12,15,17 Secondary central DI is a feature of Langerhans cell histiocytosis, germinoma, teratoma, craniopharyngioma, idiopathic giant cell granulomatous hypophysitis, and Wolfram syndrome. When DI was a presenting symptom of one of these conditions, the PBS was always absent. 7,9,12,15,17,18 In conditions in which the posterior pituitary is depleted of its vasopressin granules, the hyperintense T1 signal can also be lost. An absent PBS was observed in 32% of patients with uncontrolled diabetes mellitus 11 and in a patient with severe anorexia nervosa. 21Finally, when the pituitary stalk is interrupted, the vasopressin synthesized in the hypothalamus does not reach the posterior pituitary. The absence of a normal PBS in these cases is often accompanied by an ectopic bright spot due to the storage of vasopressin granules in another anatomical location. A patient with pituitary dwarfism was found to have an absent PBS with an ectopic bright spot. 24Acquired section of the pituitary stalk of traumatic or surgical origin has also been found to result in an absent PBS and ectopic bright spot. Object. The normal pituitary bright spot seen on unenhanced T1-weighted MRI is thought to result from the T1-shortening effect of the vasopressin stored in the posterior pituitary. Individual variations in its size may be difficult to differentiate from pathological conditions resulting in either absence of the pituitary bright spot or in T1-hyperintense lesions of the sella. The objective of this paper was to define a range of normal dimensions of the pituitary bright spot and to illustrate some of the most commonly encountered pathologies that result in absence or enlargement of the pituitary bright spot.Methods. The authors selected normal pituitary MRI studies from 106 patients with no pituitary abnormality. The size of each pituitary bright spot was measured in the longest axis and in the dimension perpendicular to this axis to describe the typical dimensions. The authors also present cases of patients with pituitary abnormalities to highlight the differences and potential ov...

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“…It should be assumed that a child or adolescent with acquired DI harbors a suprasellar germinoma until proven otherwise [1,2]. Modern noninvasive and more sensitive diagnostic procedures allow earlier detection of the tumor [1,3]. In this MRI era, however, it has to date been unanswered when and how frequently the examination should be carried out for young patients with DI whose first MRI is normal.…”

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confidence: 99%

MRI Detection of Suprasellar Germinoma Causing Central Diabetes Insipidus.

et al. 1999

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Abstract.This is a case report of an 18-year-old man with central diabetes incipidus (DI). An MRI done three months after the onset of the DI did not disclose a responsible lesion. Four months later, a second MRI showed the location of the tumor origin at the upper pituitary stalk and median eminence. Eight months later, the tumor occupied the hypothalamic area. The tumor became large and contrast-making enough to be visible on MRI between 3 and 4 months after the onst of DI. Besides the suprasellar tumor, another mass was noted in the pineal region. The growth pattern of the latter mass corresponded well to that of the former. Although the MRI is a sensitive diagnostic tool for the detection of intracranial tumors, no adequate rationale has been given as to how the MRI might be repeated for children and adolescents who have been diagnosed as having the central DI, when their initial MRIs may have been normal. In our patient, the superconductive thin slice MRI revealed the suprasellar germinoma 4 months after the onset. The suprasellar and pineal tumors in this report originated and developed simultaneously. This may indicate a multi-center origin of the tumor. Another possibility is a very early dissemination from the onset of the tumor development.

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Magnetic resonance imaging of neurohypophyseal germinomas

Cited by 60 publications

References 27 publications

Evolution of childhood central diabetes insipidus into panhypopituitarism with a large hypothalamic mass: is 'lymphocytic infundibuloneurohypophysitis' in children a different entity?

Evolution of childhood central diabetes insipidus into panhypopituitarism with a large hypothalamic mass: is 'lymphocytic infundibuloneurohypophysitis' in children a different entity?

Normal dimensions of the posterior pituitary bright spot on magnetic resonance imaging

MRI Detection of Suprasellar Germinoma Causing Central Diabetes Insipidus.

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