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Pediatric Radiology

, Volume 46, Issue 5, pp 719–726 | Cite as

Early imaging findings in germ cell tumors arising from the basal ganglia

  • So Mi Lee
  • In-One KimEmail author
  • Young Hun Choi
  • Jung-Eun Cheon
  • Woo Sun Kim
  • Hyun-Hae Cho
  • Sun Kyoung You
Original Article

Abstract

Background

It is difficult to diagnosis early stage germ cell tumors originating in the basal ganglia, but early recognition is important for better outcome.

Objective

To evaluate serial MR images of basal ganglia germ cell tumors, with emphasis on the features of early stage tumors.

Materials and methods

We retrospectively reviewed serial MR images of 15 tumors in 14 children and young adults. We categorized MR images of the tumors as follows: type I, ill-defined patchy lesions (<3 cm) without cyst; type II, small mass lesions (<3 cm) with cyst; and type III, large lesions (≥3 cm) with cyst. We also assessed temporal changes of the MR images.

Results

On the initial images, 8 of 11 (73%) type I tumors progressed to types II or III, and 3 of 4 (75%) type II tumors progressed to type III. The remaining 4 tumors did not change in type. All type II tumors (5/5, 100%) that changed from type I had a few tiny cysts. Intratumoral hemorrhage was observed even in the type I tumor. Ipsilateral hemiatrophy was observed in most of the tumors (13/15, 87%) on initial MR images. As tumors grew, cystic changes, intratumoral hemorrhage, and ipsilateral hemiatrophy became more apparent.

Conclusion

Early stage basal ganglia germ cell tumors appear as ill-defined small patchy hyperintense lesions without cysts on T2-weighted images, are frequently associated with ipsilateral hemiatrophy, and sometimes show microhemorrhage. Tumors develop tiny cysts at a relatively early stage.

Keywords

Adolescent Basal ganglia Child Early stage Germ cell tumor Magnetic resonance imaging Serial images 

Notes

Compliance with ethical standards

Conflicts of interest

None

References

  1. 1.
    Packer RJ, Cohen BH, Cooney K (2000) Intracranial germ cell tumors. Oncologist 5:312–320PubMedGoogle Scholar
  2. 2.
    Echevarria ME, Fangusaro J, Goldman S (2008) Pediatric central nervous system germ cell tumors: a review. Oncologist 13:690–699CrossRefPubMedGoogle Scholar
  3. 3.
    Raybaud C, Barkovich AJ et al (2012) Intracranial, orbital, and neck masses of childhood. In: Barkovich AJ, Raybaud C (eds) Pediatric neuroimaging. Lippincott Williams & Wilkins, PhiladelphiaGoogle Scholar
  4. 4.
    Crawford JR, Santi MR, Vezina G et al (2007) CNS germ cell tumor (CNSGCT) of childhood: presentation and delayed diagnosis. Neurology 68:1668–1673CrossRefPubMedGoogle Scholar
  5. 5.
    Soejima T, Takeshita I, Yamamoto H et al (1987) Computed tomography of germinomas in basal ganglia and thalamus. Neuroradiology 29:366–370CrossRefPubMedGoogle Scholar
  6. 6.
    Okamoto K, Ito J, Ishikawa K et al (2002) Atrophy of the basal ganglia as the initial diagnostic sign of germinoma in the basal ganglia. Neuroradiology 44:389–394CrossRefPubMedGoogle Scholar
  7. 7.
    Higano S, Takahashi S, Ishii K et al (1994) Germinoma originating in the basal ganglia and thalamus: MR and CT evaluation. AJNR Am J Neuroradiol 15:1435–1441PubMedGoogle Scholar
  8. 8.
    Rasalkar DD, Chu WC, Cheng FW et al (2010) Atypical location of germinoma in basal ganglia in adolescents: radiological features and treatment outcomes. Br J Radiol 83:261–267CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Kim DI, Yoon PH, Ryu YH et al (1998) MRI of germinomas arising from the basal ganglia and thalamus. Neuroradiology 40:507–511CrossRefPubMedGoogle Scholar
  10. 10.
    Moon WK, Chang KH, Kim IO et al (1994) Germinomas of the basal ganglia and thalamus: MR findings and a comparison between MR and CT. AJR Am J Roentgenol 162:1413–1417CrossRefPubMedGoogle Scholar
  11. 11.
    Lou X, Ma L, Wang FL et al (2009) Susceptibility-weighted imaging in the diagnosis of early basal ganglia germinoma. AJNR Am J Neuroradiol 30:1694–1699CrossRefPubMedGoogle Scholar
  12. 12.
    Lou X, Tian C, Chen Z et al (2012) Differential diagnosis of infarct-like intracranial ectopic germinomas and subacute lacunar infarct on susceptibility-weighted imaging. J Magn Reson Imaging 36:92–98CrossRefPubMedGoogle Scholar
  13. 13.
    Ozelame RV, Shroff M, Wood B et al (2006) Basal ganglia germinoma in children with associated ipsilateral cerebral and brain stem hemiatrophy. Pediatr Radiol 36:325–330CrossRefPubMedGoogle Scholar
  14. 14.
    Phi JH, Cho BK, Kim SK et al (2010) Germinomas in the basal ganglia: magnetic resonance imaging classification and the prognosis. J Neurooncol 99:227–236CrossRefPubMedGoogle Scholar
  15. 15.
    Wong ST, Yuen SC, Fong D (2009) Pathophysiological mechanism of ipsilateral cerebral and brainstem hemiatrophy in basal ganglia germ cell tumors: case report. Childs Nerv Syst 25:693–699CrossRefPubMedGoogle Scholar
  16. 16.
    Fujii Y, Saito Y, Ogawa T et al (2008) Basal ganglia germinoma: diagnostic value of MR spectroscopy and (11)C-methionine positron emission tomography. J Neurol Sci 270:189–193CrossRefPubMedGoogle Scholar
  17. 17.
    Lee J, Lee BL, Yoo KH et al (2009) Atypical basal ganglia germinoma presenting as cerebral hemiatrophy: diagnosis and follow-up with 11C-methionine positron emission tomography. Childs Nerv Syst 25:29–37CrossRefPubMedGoogle Scholar
  18. 18.
    Sudo A, Shiga T, Okajima M et al (2003) High uptake on 11C-methionine positron emission tomographic scan of basal ganglia germinoma with cerebral hemiatrophy. AJNR Am J Neuroradiol 24:1909–1911PubMedGoogle Scholar
  19. 19.
    Jager PL, Vaalburg W, Pruim J et al (2001) Radiolabeled amino acids: basic aspects and clinical applications in oncology. J Nucl Med 42:432–445PubMedGoogle Scholar
  20. 20.
    Nakagawa M, Kuwabara Y, Sasaki M et al (2002) 11C-methionine uptake in cerebrovascular disease: a comparison with 18F-fDG PET and 99mTc-HMPAO SPECT. Ann Nucl Med 16:207–211CrossRefPubMedGoogle Scholar
  21. 21.
    Coakley J, Kellie SJ, Nath C et al (2005) Interpretation of alpha-fetoprotein concentrations in cerebrospinal fluid of infants. Ann Clin Biochem 42:24–29CrossRefPubMedGoogle Scholar
  22. 22.
    Fujimaki T, Mishima K, Asai A et al (2000) Levels of beta-human chorionic gonadotropin in cerebrospinal fluid of patients with malignant germ cell tumor can be used to detect early recurrence and monitor the response to treatment. Jpn J Clin Oncol 30:291–294CrossRefPubMedGoogle Scholar
  23. 23.
    Tang J, Ma Z, Luo S et al (2008) The germinomas arising from the basal ganglia and thalamus. Childs Nerv Syst 24:303–306CrossRefPubMedGoogle Scholar
  24. 24.
    Kwak R, Suzuki J (1970) Brain tumor with ipsilateral cerebral hemiatrophy. No To Shinkei 22:1439–1446PubMedGoogle Scholar
  25. 25.
    Kuhn MJ, Johnson KA, Davis KR (1988) Wallerian degeneration: evaluation with MR imaging. Radiology 168:199–202CrossRefPubMedGoogle Scholar
  26. 26.
    Mutoh K, Okuno T, Ito M et al (1988) Ipsilateral atrophy in children with hemispheric cerebral tumors: CT findings. J Comput Assist Tomogr 12:740–743CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • So Mi Lee
    • 1
    • 3
  • In-One Kim
    • 2
    Email author
  • Young Hun Choi
    • 2
  • Jung-Eun Cheon
    • 2
  • Woo Sun Kim
    • 2
  • Hyun-Hae Cho
    • 1
    • 4
  • Sun Kyoung You
    • 1
    • 5
  1. 1.Department of RadiologySeoul National University College of MedicineSeoulRepublic of Korea
  2. 2.Department of Radiology and Institute of Radiation MedicineSeoul National University College of MedicineSeoulRepublic of Korea
  3. 3.Department of RadiologyKyungpook National University Medical CenterDaeguRepublic of Korea
  4. 4.Department of RadiologyEwha Woman’s University Mokdong HospitalSeoulSouth Korea
  5. 5.Department of RadiologyChungnam National University HospitalDaejeonRepublic of Korea

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