Primary Intramedullary Spinal Cord Germinoma: Diagnostic Challenge and Treatment Strategy  -Two Case Reports-

Yamagata, Toru; Takami, Toshihiro; Tsuyuguchi, Naohiro; Goto, Takeo; Wakasa, Kenichi; Ohata, Kenji

doi:10.2176/nmc.49.128

Cited by 11 publications

(3 citation statements)

References 26 publications

(25 reference statements)

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“…Among the previous reports of primary spinal cord germinoma, we summarized cases that required >1 year from the onset of symptoms for an accurate diagnosis (Table 1). [11][12][13][14][15][16][17][18][19] The tumor is commonly located at the thoracic level, and patients usually develop lower-extremity symptoms. Two case reports (Cases 3 and 8) showed no abnormal findings on the initial MRI after onset, but there were abnormal findings on the follow-up MRI.…”

Section: Discussionmentioning

confidence: 99%

“…2) There is a method for determining postoperative chemotherapy and radiation according to prognostic classification based on the histology of the tumor, consistent with the treatment strategy for primary germ cell tumors of the CNS in Japan. 16,21) When a case is classified into the good prognosis group with pure germinoma, chemotherapy using cisplatin and etoposide and local radiation are recommended as postoperative adjuvant therapy.…”

Section: Discussionmentioning

confidence: 99%

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Occult Germinoma of the Intramedullary Spinal Cord: A Case Report

HOSHIMARU

TAKAGI

Tsuji

et al. 2023

NMC Case Report Journal

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Primary germ cell tumors of the central nervous system (CNS) typically occur in the neurohypophysis, hypothalamus, or pineal gland and rarely in the spinal cord. We report a case of a spinal intramedullary tumor, which was first detected on magnetic resonance imaging (MRI) 41 months after the initial symptoms, with a verified pathological diagnosis of germinoma. The initial symptom was an abnormal sensation in the left plantar region that gradually worsened, resulting in severe sensory disturbance, difficulty in standing, and even bladder rectal disturbance. Repeated MRI after the onset failed to provide an imaging diagnosis. The MRI was performed 41 months after the onset and revealed a previously undiagnosed, contrast-enhancing spinal intramedullary neoplastic lesion at the Th11-12 level. Gross total resection of the tumor was successfully performed, and the pathology confirmed the diagnosis of pure germinoma. Postoperative chemotherapy, followed by local radiation, was successfully administered. Among primary germinomas of the CNS, occult germinoma that lacks imaging findings suggestive of tumors in the early stages of onset and becomes apparent over time is often reported as a primary neurohypophyseal germinoma, particularly in adolescents presenting with diabetes insipidus. In the present case, the lesion appeared to correspond to a primary occult germinoma of the intramedullary spinal cord.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Occult Germinoma of the Intramedullary Spinal Cord: A Case Report

HOSHIMARU

TAKAGI

Tsuji

et al. 2023

NMC Case Report Journal

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“…Primary cluding 27 cases of pure germinoma (71%), 5 cases of germinoma with syncytiotrophoblastic giant cells (STGCs) (13%), 3 cases of mixed germ cell tumor (8%), 2 cases of yolk sac tumor (5%), and 1 case of embryonal carcinoma (3%). 1,2,5,7,9,11,12,16,[19][20][21] The proportion of NGGCTs among primary spinal germ cell tumors appears slightly lower than that among intracranial germ cell tumors. 15 Among these 38 cases, 25 (66%) involved Japanese patients and 19 (50%) involved male patients.…”

Section: Primary Spinal Germ Cell Tumorsmentioning

confidence: 96%

Successful treatment of mixed yolk sac tumor and mature teratoma in the spinal cord: case report

Mukasa¹,

Yanagisawa²,

Tanaka³

et al. 2017

SPI

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Primary spinal germ cell tumors are rare, and spinal nongerminomatous germ cell tumors represent an even rarer subset for which no standard therapy has been established. The authors report the case of a 24-year-old woman with multifocal primary spinal germ cell tumors scattered from T-12 to L-5 that consisted of yolk sac tumor and mature teratoma. After diagnostic partial resection, the patient was treated with 30 Gy of craniospinal irradiation and 30 Gy of local spinal irradiation, followed by 8 courses of chemotherapy based on ifosfamide, cisplatin, and etoposide (ICE). Salvage surgery was also performed for residual mature teratoma components after the third course of ICE chemotherapy. Chemotherapy was continued after the operation, but ifosfamide was entirely eliminated from the ICE regimen because severe myelosuppression was observed after previous courses. The patient remains recurrence free as of more than 5 years after the completion of chemotherapy. This case suggests that this treatment strategy is an effective option for primary spinal yolk sac tumor.

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