Abstract
Background
Central nervous system (CNS) germ cell tumors account for 3 % of all pediatric brain tumors in the USA. Presenting symptoms are typically location based with pineal tumors presenting with obstructive hydrocephalus and suprasellar tumors with hypothalamic/pituitary dysfunction and ophthalmologic abnormalities. Psychiatric manifestations such as psychosis and behavioral changes are atypical presentations of CNS germ cell tumors, with only 11 previously reported cases.
Methods
This is a retrospective case series describing patients with CNS germ cell tumors with an atypical presentation including psychiatric manifestations. Information regarding clinical presentation, treatment course, and outcome were obtained.
Results
We report seven patients who presented with psychiatric symptoms consisting of psychomotor delay as well as behavioral and mood changes. Six of the seven patients were diagnosed ≥6 months after onset of psychiatric symptoms. All of the seven are alive but five continue to have neurologic and psychiatric issues post treatment.
Conclusions
Atypical presentations of CNS germ cell tumors can delay diagnosis and treatment and may be secondary to atypical locations as well as endocrine dysfunction manifesting as psychiatric symptoms. Delayed diagnosis did not appear to affect survival but earlier diagnosis may potentially be associated with better neurologic and psychiatric outcome. Patients who present with these symptoms and atypical neuroimaging should have a thorough evaluation for CNS germ cell tumors including serum and CSF markers. Clinicians should be aware of these less common presentations to aid in prompt diagnosis and treatment.
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References
Crawford JR, Santi MR, Vezina G et al (2007) CNS germ cell tumor of childhood (CNSGCT) presentation and delayed diagnosis. Neurology 68:1668–1673
Echevarria ME, Fangusaro J, Goldman S (2008) Pediatric central nervous system germ cell tumors: a review. Oncologist 13:690–699
Winston AP, Barnard D, D’Souza G et al (2006) Pineal germinoma presenting as anorexia nervosa: case report and review of the literature. Int J Eat Disord 39:606–608
Undurraga J, Baeza I, Valenti M et al (2010) Case report: brain germinoma presenting as a first psychotic episode in an adolescent male. Eur Child Adolesc Psychiatry 19:741–742
Sartori S, Laverda AM, Calderone M et al (2007) Germinoma with synchronous involvement of midline and off midline structures associated with progressive hemiparesis and hemiatrophy in a young adult. Childs Nerv Syst 23:1341–1345
Mittal VA, Karlsgodt K, Zinberg J et al (2010) Identification and treatment of a pineal region tumor in an adolescent with prodromal psychotic symptoms. Am J Psychiatry 167:1033–1037
Heathcote AC, Wormald JC, Stocks R (2012) An unusual suspect causing behavioral problems and pituitary failure in a child. BMJ Case Rep 14:2012
Etzioni A, Luboshitzky R, Tiosano D et al (1996) Melatonin replacement corrects sleep disturbances in a child with pineal tumor. Neurology 46:261–263
Winston AP, Barnard DD, D’souza G et al (2006) Pineal germinoma presenting as anorexia nervosa: case report and review of the literature. Int J Eat Disord 39:606–8
Popkin MK, Mackenzie TB. Psychiatric presentations of medical illness. Somatopsychic disorders. New York: Spectrum publications, 1980. Print
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Malbari, F., Gershon, T.R., Garvin, J.H. et al. Psychiatric manifestations as initial presentation for pediatric CNS germ cell tumors, a case series. Childs Nerv Syst 32, 1359–1362 (2016). https://doi.org/10.1007/s00381-016-3145-8
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DOI: https://doi.org/10.1007/s00381-016-3145-8