Advertisement

Pineal Germ Cell Tumor with Upgaze Palsy

  • An-Guor Wang
Chapter

Abstract

A 14-year-old boy presented with complaints of diplopia for 1 month. He had a minor head injury 1 week before the onset of diplopia. He was hit in the head with a ball, but did not report feeling any significant discomfort at that time. He began to experience double vision afterward and visited a local ophthalmologist. He was subsequently transferred to our clinic. His vision was 6/6.7 in the right and 6/6 in the left. Color vision and intraocular pressures were normal. Anterior segments were normal. Ophthalmoscopic examination showed normal fundi in both eyes (Fig. 40.1). A prism cover test revealed 1 prism diopter of left hypertropia on primary gaze and increased measurements on right gaze and left tilt. The results of a park three-step test were compatible with left trochlear nerve palsy. An extraocular movement examination showed moderate limitation of upgaze in both eyes (Fig. 40.2, Video 40.1). Visual field testing revealed enlarged blind spots in both eyes (Fig. 40.3). MRI showed a pineal tumor with cystic space, which was isointense on T1-weighted images and hyperintense on T2-weighted images. The tumor was enhanced after gadolinium injection (Fig. 40.4). Under the impression of germ cell tumor, there was subtle seeding into third ventricle noted along with associated obstructive hydrocephalus. A peripheral blood examination demonstrated increased AFP (3295 ng/mL) and β-HCG (151 mIU/mL). The patient hesitated to receive surgical biopsy, and there was subsequent loss to follow-up.

Supplementary material

Video 40.1

(MOV 59008 kb)

References

  1. 1.
    Penn A, Jenney MEM, Nicholson JC. Germ cell tumours in children and adolescents. Paediatr Child Health. 2014;24(4):148–54.CrossRefGoogle Scholar
  2. 2.
    Nagasawa DT, Lagman C, Sun M, Yew A, Chung LK, Lee SJ, Bui TT, Ooi YC, Robison RA, Zada G, Yang I. Pineal germ cell tumors: two cases with review of histopathologies and biomarkers. J Clin Neurosci. 2017;38:23–31.CrossRefPubMedGoogle Scholar
  3. 3.
    Hoffman HJ, Otsubo H, Hendrick EB, Humphreys RP, Drake JM, Becker LE, Greenberg M, Jenkin D. Intracranial germ-cell tumors in children. J Neurosurg. 1991;74(4):545–51.CrossRefPubMedGoogle Scholar
  4. 4.
    Wong AME. Eye movement disorders. Oxford: Oxford University Press; 2008. p. 140–1.Google Scholar
  5. 5.
    Kilgore DP, Strother CM, Starshak RJ, Haughton VM. Pineal germinoma: MR imaging. Radiology. 1986;158(2):4358.CrossRefGoogle Scholar
  6. 6.
    Liang L, Korogi Y, Sugahara T, Ikushima I, Shigematsu Y, Okuda T, Takahashi M, Kochi M, Ushio Y. MRI of intracranial germ cell tumours. Neuroradiology. 2002;44(5):3828.CrossRefGoogle Scholar
  7. 7.
    Wolden SL, Wara WM, Larson DA, et al. Radiation therapy for primary intracranial germ-cell tumors. Int J Radiat Oncol Biol Phys. 1995;32:943–9.CrossRefPubMedGoogle Scholar
  8. 8.
    Haas-Kogan DA, Missett BT, Wara WM, et al. Radiation therapy for intracranial germ cell tumors. Int J Radiat Oncol Biol Phys. 2003;56:511–8.CrossRefPubMedGoogle Scholar
  9. 9.
    Jensen AW, Laack NN, Buckner JC, et al. Long-term follow-up of dose-adapted and reduced-field radiotherapy with or without chemotherapy for central nervous system germinoma. Int J Radiat Oncol Biol Phys. 2010;77:1449–56.CrossRefPubMedGoogle Scholar
  10. 10.
    Calaminus G, Bamberg M, Jurgens H, et al. Impact of surgery, chemotherapy and irradiation on long term outcome of intracranial malignant nongerminomatous germ cell tumors: results of the German Cooperative Trial MAKEI 89. Klin Padiatr. 2004;216:141–9.CrossRefPubMedGoogle Scholar
  11. 11.
    Kochi M, Itoyama Y, Shiraishi S, et al. Successful treatment of intracranial nongerminomatous malignant germ cell tumors by administering neoadjuvant chemotherapy and radiotherapy before excision of residual tumors. J Neurosurg. 2003;99:106–14.CrossRefPubMedGoogle Scholar
  12. 12.
    Balmaceda C, Finlay J. Current advances in the diagnosis and management of intracranial germ cell tumors. Curr Neurol Neurosci Rep. 2004;4:253–62.CrossRefPubMedGoogle Scholar
  13. 13.
    Matsutani M, Sano K, Takakura K, et al. Primary intracranial germ cell tumors: a clinical analysis of 153 histologically verified cases. J Neurosurg. 1997;86:446–55.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2018

Authors and Affiliations

  • An-Guor Wang
    • 1
  1. 1.Department of OphthalmologyTaipei Veterans General Hospital, National Yang-Ming University School of Medicine, Yun-San Ophthalmology Education Research FoundationTaipeiTaiwan

Personalised recommendations