Mixed Germinoma and Choriocarcinoma in the Intramedullary Spinal Cord: Case Report and Review of the Literature

Abstract

Primary germinomas in the spinal cord are very rare with only 15 cases published previously. In this case a 22-year-old woman with urinary incontinence, lumbago, and bilateral leg pain and weakness was found to have a solid tumor in the conus medullaris between the L1 and L2 vertebral bodies. Serum HCG was elevated without pregnancy. The pathological diagnosis was mixed germinoma and choriocarcinoma of the intramedullary spinal cord. She received craninospinal irradiation and three courses of chemotherapy and is currently asymptomatic with no evidence of recurrence and metastasis 22 months after surgery. To our knowledge, this is the first case report of a patient with a primary mixed germinoma and choriocarcinoma of the intramedullary spinal cord. The previous 15 cases of primary spinal cord germinoma have been reviewed for comparison.

A Case of Lumbar Metastasis of Choriocarcinoma Masquerading as an Extraosseous Extension of Vertebral Hemangioma

“…GTDs encompass a heterogeneous group of neoplastic disorders that arise from the trophoblastic epithelium of the placenta and they are characterized by a distinct tumor marker (β-HCG) 1,7,8,11,12,17,20,22,23,25) . GTDs are conventionally classified into at least five distinct groups on the basis of their histopathologic, cytogenetic, and clinical features 12) .…”

“…In the case we have described, the patient presented with metastases to the lung, brain parenchyma and lumbar spine. The lung and brain have been described as the most common sites for metastasis in the literature 1,2,4,11,12,15,20,21,23,25) . Yet, metastasis in the musculoskeletal system, such as the spine, is extremely rare and this can be seen from the scant reported cases 4,[14][15][16]20,21) .…”

“…It can appear after an intrauterine or an ectopic pregnancy and it is more common after a hydatidiform mole. Choriocarcinoma is associated with a high human chorionic gonadotrophin (HCG) level and rapid hematogenous spread to multiple organs 1,7,8,12,20,22,23,25) . The most common locations for metastases are the lung and the vulvo-vaginal region, and metastases are less commonly found in the brain and liver.…”

“…The most common locations for metastases are the lung and the vulvo-vaginal region, and metastases are less commonly found in the brain and liver. Other sites of metastases, such as the skin, gastrointestinal tract, kidney, breast or bones, are extremely rare 2,4,11,12,15,[20][21][22][23][24] . In this study, we report on a case of metastatic choriocarcinoma that presented with intracerebral hemorrhage and pulmonary hemorrhage and it metastasized to the lumbar spine, and this metastasis to the spine radiologically mimicked an extraosseous extension of vertebral hemangioma.…”

Isolated intraspinal germinoma in a child with congenital adrenal hyperplasia

“…1 However, to date, there are only 15 previously reported cases of intramedullary spinal cord germinomas found in the literature, which have been predominantly in the thoracolumbar cord. 1 The majority of these cases are found in the Japanese literature. Germinomas have been found in patients with 21-hydroxylase deficiency with elevated 17-hydroxyprogesterone levels, but these have been intracranial lesions.…”