GERMINOMA WITH INVOLVEMENT OF OFF-MIDLINE INTRACRANIAL STRUCTURES: A CASE REPORT

SHANSHAN ZHAO1, JINGLIANG CHENG1, FUYOU GUO2, WENZHENG LUO2, JIE BAI1

1Department of magnetic resonance, the First Affiliated Hospital of Zhengzhou University, China - 2Department of Neurosurgery, the First Affiliated Hospital of Zhengzhou University, China

Introduction: The exercised skeletal muscle may induce oxidative stress (OS) leading to contractile dysfunction, fatigue and weakness during a strPrimary germ cell tumor presents with diverse clinical symptoms and imaging features. Less than 10% are lo- calized in off-middle structures, and only midline involvement of parenchyma has been extensively researched. A case of a 21-year-old male patient with progressive mental disorder and intermittent fever was reviewed. Brain MRI showed demyelinating lesion at the par- aventricular side of the lateral ventricle at an early stage. Alfa-fetoprotein (AFP) levels were negative in both serum and cerebrospinal fluid (CSF). Misdiagnoses were made frequently. When MRI displayed a cystic and solid lesion at the left frontal lobe, a clear diagnosis could not be given with clinical, laboratory and imaging examinations. Thus, we performed craniotomy and removed the intracranial lesions. The pathological results showed that the tissue morphology and immunohistochemistry were indicative of germ cell tumor, and CD117 and PLAP immunohistochemical staining was positive.

Germ cell tumors represent approximately 3% of the malignant tumors in children(1). They account for 0.1 to 2.4% of all childhood intracranial tumors in North America and Europe, while they constitute almost 2.1 to 9.5% of tumors in Japan and the Far East(2,3). Primary central nervous system germ cell tumors are rare, and most occur in patients between 10-20 years old(4). The diagnosis of the disease is very challenging due to the its diverse clinical manifestations(5). Central nervous germ cell tumors have been divided into secreting and non-secreting classifications. Secreting tumors present with an elevated CSF AFP ≥ 10 ng/mL or

 Conclusion: Germinoma must be considered in patients with demyelinating lesion at the midline and with a long history of men- tal disorders. In addition, ectopic germinoma must be suspected in these patients. Although a rare condition, colocalization of midline and off-midline germinoma must be considered in the presence of these typical signs of both localizations.