Journal of Neuro-Oncology

, Volume 99, Issue 2, pp 227–236 | Cite as

Germinomas in the basal ganglia: magnetic resonance imaging classification and the prognosis

  • Ji Hoon Phi
  • Byung-Kyu Cho
  • Seung-Ki Kim
  • Jin Chul Paeng
  • In-One Kim
  • Il Han Kim
  • Dong Gyu Kim
  • Hee-Won Jung
  • Jeong Eun Kim
  • Kyu-Chang Wang
Clinical Study - Patient Study

Abstract

Germinoma in the basal ganglia (BG) is notorious for its diagnostic difficulty. Clinical and radiological features of this disease are quite diverse, but have not been well characterized with respect to prognosis. We retrospectively reviewed the clinical course and treatment outcomes of 17 patients with a BG germinoma. The initial magnetic resonance imaging (MRI) features were classified. Clinical features and treatment outcomes were then analyzed with this classification scheme. A Type 1 lesion was defined as a subtle lesion with faint or no contrast enhancement (six patients). Type 2, 3, and 4 lesions were defined as contrast-enhancing lesions and were differentiated by the lesion size and the presence of subependymal seeding (11 patients). Type 1 lesions were distinct from the other lesions. Patients with a Type 1 lesion had a significantly longer time from the initial MRI to diagnosis than patients with Type 2, 3, and 4 lesions (P = 0.012). The actuarial progression-free survival and overall survival of patients 5 years after diagnosis were 66 and 77%, respectively. The presence of a Type 1 lesion (P = 0.004), a longer time delay in the diagnosis (P = 0.038), and radiation therapy without complete ventricular coverage (P = 0.010) were significantly associated with tumor progression. Profound motor deficits at diagnosis were associated with deterioration in motor function after tumor remission (P = 0.035). Early diagnosis of BG germinomas could affect the ability to control a tumor and neurological outcomes. In particular, high clinical suspicion and active diagnostic procedures are recommended. For optimal treatment, radiation fields should include entire ventricles even if there is no subependymal seeding.

Keywords

Germinoma Basal ganglia Magnetic resonance imaging Prognosis Motor function 

References

  1. 1.
    Sano K (1999) Pathogenesis of intracranial germ cell tumors reconsidered. J Neurosurg 90:258–264CrossRefPubMedGoogle Scholar
  2. 2.
    Matsutani M, Sano K, Takakura K, Fujimaki T, Nakamura O, Funata N et al (1997) Primary intracranial germ cell tumors: a clinical analysis of 153 histologically verified cases. J Neurosurg 86:446–455CrossRefPubMedGoogle Scholar
  3. 3.
    Utsuki S, Oka H, Tanizaki Y, Kondo K, Fujii K (2005) Radiological features of germinoma arising from atypical locations. Neurol Med Chir (Tokyo) 45:268–271CrossRefGoogle Scholar
  4. 4.
    Sonoda Y, Kumabe T, Sugiyama S, Kanamori M, Yamashita Y, Saito R et al (2008) Germ cell tumors in the basal ganglia: problems of early diagnosis and treatment. J Neurosurg Pediatr 2:118–124CrossRefPubMedGoogle Scholar
  5. 5.
    Tamaki N, Lin T, Shirataki K, Hosoda K, Kurata H, Matsumoto S et al (1990) Germ cell tumors of the thalamus and the basal ganglia. Childs Nerv Syst 6:3–7CrossRefPubMedGoogle Scholar
  6. 6.
    Takeda N, Fujita K, Katayama S, Uchihashi Y, Okamura Y, Nigami H et al (2004) Germinoma of the basal ganglia. An 8-year asymptomatic history after detection of abnormality on CT. Pediatr Neurosurg 40:306–311CrossRefPubMedGoogle Scholar
  7. 7.
    Kawai N, Miyake K, Nishiyama Y, Yamamoto Y, Miki A, Haba R et al (2008) Targeting optimal biopsy location in basal ganglia germinoma using (11)C-methionine positron emission tomography. Surg Neurol 70:408–413CrossRefPubMedGoogle Scholar
  8. 8.
    Wang KC, Kim SK, Park SH, Kim IO, Cho BK (2006) Intracranial germ cell tumors. In: Tonn JC, Westphal M, Rutka JT et al (eds) Neuro-oncology of CNS tumors. Springer, Berlin, pp 517–527CrossRefGoogle Scholar
  9. 9.
    Kim CH, Paek SH, Park IA, Chi JG, Kim DG (2002) Cerebral germinoma with hemiatrophy of the brain: report of three cases. Acta Neurochir (Wien) 144:145–150CrossRefGoogle Scholar
  10. 10.
    Nagata K, Nikaido Y, Yuasa T, Fujimoto K, Kim YJ, Inoue M (1998) Germinoma causing wallerian degeneration. Case report and review of the literature. J Neurosurg 88:126–128CrossRefPubMedGoogle Scholar
  11. 11.
    Moon WK, Chang KH, Kim IO, Han MH, Choi CG, Suh DC et al (1994) Germinomas of the basal ganglia and thalamus: MR findings and a comparison between MR and CT. AJR Am J Roentgenol 162:1413–1417PubMedGoogle Scholar
  12. 12.
    Osuka S, Tsuboi K, Takano S, Ishikawa E, Matsushita A, Tokuuye K et al (2007) Long-term outcome of patients with intracranial germinoma. J Neurooncol 83:71–79CrossRefPubMedGoogle Scholar
  13. 13.
    Okamoto K, Ito J, Ishikawa K, Morii K, Yamada M, Takahashi N et al (2002) Atrophy of the basal ganglia as the initial diagnostic sign of germinoma in the basal ganglia. Neuroradiology 44:389–394CrossRefPubMedGoogle Scholar
  14. 14.
    Ozelame RV, Shroff M, Wood B, Bouffet E, Bartels U, Drake JM et al (2006) Basal ganglia germinoma in children with associated ipsilateral cerebral and brain stem hemiatrophy. Pediatr Radiol 36:325–330CrossRefPubMedGoogle Scholar
  15. 15.
    Tang J, Ma Z, Luo S, Zhang Y, Jia G, Zhang J (2008) The germinomas arising from the basal ganglia and thalamus. Childs Nerv Syst 24:303–306CrossRefPubMedGoogle Scholar
  16. 16.
    Musumeci A, Cristofori L, Bricolo A (2000) Persistent hiccup as presenting symptom in medulla oblongata cavernoma: a case report and review of the literature. Clin Neurol Neurosurg 102:13–17CrossRefPubMedGoogle Scholar
  17. 17.
    Birnbaum T, Pellkofer H, Buettner U (2008) Intracranial germinoma clinically mimicking chronic progressive multiple sclerosis. J Neurol 255:775–776CrossRefPubMedGoogle Scholar
  18. 18.
    Ramelli GP, Von der Weid N, Stanga Z, Mullis PE, Buergi U (1998) Suprasellar germinomas in childhood and adolescence: diagnostic pitfalls. J Pediatr Endocrinol Metab 11:693–697PubMedGoogle Scholar
  19. 19.
    Lee J, Lee BL, Yoo KH, Sung KW, Koo HH, Lee SJ et al (2009) Atypical basal ganglia germinoma presenting as cerebral hemiatrophy: diagnosis and follow-up with (11)C-methionine positron emission tomography. Childs Nerv Syst 25:29–37CrossRefPubMedGoogle Scholar
  20. 20.
    Sudo A, Shiga T, Okajima M, Takano K, Terae S, Sawamura Y 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
  21. 21.
    Kawabata Y, Takahashi JA, Arakawa Y, Shirahata M, Hashimoto N (2008) Long term outcomes in patients with intracranial germinomas: a single institution experience of irradiation with or without chemotherapy. J Neurooncol 88:161–167CrossRefPubMedGoogle Scholar
  22. 22.
    Haddock MG, Schild SE, Scheithauer BW, Schomberg PJ (1997) Radiation therapy for histologically confirmed primary central nervous system germinoma. Int J Radiat Oncol Biol Phys 38:915–923PubMedGoogle Scholar
  23. 23.
    Nakamura H, Takeshima H, Makino K, Kochi M, Ushio Y, Kuratsu J (2006) Recurrent intracranial germinoma outside the initial radiation field: a single-institution study. Acta Oncol 45:476–483CrossRefPubMedGoogle Scholar
  24. 24.
    Tsuchida Y, Tsuboi K, Yanaka K, Nose T (1993) Basal ganglia germinoma with crossed cerebellar diaschisis—case report. Neurol Med Chir (Tokyo) 33:779–782CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC. 2010

Authors and Affiliations

  • Ji Hoon Phi
    • 1
  • Byung-Kyu Cho
    • 1
  • Seung-Ki Kim
    • 1
  • Jin Chul Paeng
    • 2
  • In-One Kim
    • 3
  • Il Han Kim
    • 4
  • Dong Gyu Kim
    • 1
  • Hee-Won Jung
    • 1
  • Jeong Eun Kim
    • 1
  • Kyu-Chang Wang
    • 1
  1. 1.Department of Neurosurgery, Seoul National University College of MedicineSeoul National University HospitalSeoulRepublic of Korea
  2. 2.Department of Nuclear MedicineSeoul National University College of Medicine, Seoul National University HospitalSeoulRepublic of Korea
  3. 3.Department of Diagnostic Radiology, Seoul National University College of MedicineSeoul National University HospitalSeoulRepublic of Korea
  4. 4.Department of Radiation Oncology and Cancer Research InstituteSeoul National University College of Medicine, Seoul National University HospitalSeoulRepublic of Korea

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