Clin Neuroradiol DOI 10.1007/s00062-015-0380-4

Correspondence

Teaching Neuroimages: Basal Ganglia Germinoma with Hemiatrophy C.J. Maurer · M. Trippel · R. Korinthenberg · H. Urbach

Received: 30 October 2014 / Accepted: 24 February 2015 © Springer-Verlag Berlin Heidelberg 2015

A 15-year-old Caucasian boy presented with an overmonths slowly progressive hemiparesis, first of his right arm and eventually of his right leg (grade 4/5). He suffered from speech deterioration with worsening of articulation and fluency, declining school performance, and repetitive nocturnal enuresis. He was considered to have longstanding right-sided facial palsy due to an ischemic event in early infancy, although no imaging study was performed at that time. Magnetic resonance imaging showed a multicystic lesion associated with atrophy of the left basal ganglia (Fig. 1a). The white matter of the anterior frontal lobe and the left basal ganglia showed a fluid-attenuated inversion recovery hyperintense signal, a high signal in diffusionweighted images at a b-value of 1000 (Fig. 1b), and—more remarkably—tiny, partly enhancing cysts along the genu of the corpus callosum and the right caudate head (Fig. 1c). Unenhanced computed tomography (CT) showed these

structures to be hyperdense (Fig. 1d). Stereotactic biopsy of the contrast-enhancing lesion at the tip of the left frontal horn revealed a germinoma. Approximately 50–65  % of intracranial germinomas occur in the pineal region, approximately 30 % in the suprasellar region, and only 5–10 % of all intracranial germinomas in the basal ganglia/thalamus region [1, 4]. Those located in the basal ganglia/thalamus have a striking male predominance, tend to have a rather benign course, are in approximately 20 % cases associated with basal ganglia atrophy, and the tumor itself may be overlooked for years [1–3, 5, 6]. One should be aware of this pattern and carefully search for the rather specific tumor texture (reduced diffusion, CT hyperdensity) caused by its high cellularity due to abundant lymphocytes within the tumor [4].

C. Maurer () · H. Urbach Department of Neuroradiology, University Medical Center Freiburg, Breisacher Straße 64, 79106 Freiburg, Germany e-mail: [email protected]

References

M. Trippel Department of Neurosurgery, University Medical Center Freiburg, Breisacher Straße 64, 79106 Freiburg, Germany R. Korinthenberg Center of Pediatrics, University Medical Center Freiburg, Breisacher Straße 64, 79106 Freiburg, Germany

Conflict of Interest  On behalf of all authors, the corresponding author states that there is no conflict of interest.

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Fig. 1  (a) axial T2-weighted image, (b) DWI (b-value=1000), (c) T1-weighted image after administration of contrast medium, (d) unenhanced axial CT scan 4. Smith AB, Rushing EJ, Smirniotopoulos JG. From the archives of the AFIP: lesions of the pineal region: radiologic-pathologic correlation. Radiographics. 2010;30:2001–20. 5. Takeda N, Fujita K, Katayama S, Uchihashi Y, Okamura Y, Nigami H, Hashimoto K, Kohmura E. Germinoma of the basal ganglia. An 8-year asymptomatic history after detection of abnormality on CT. Pediatr Neurosurg. 2004;40:306–11.

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Teaching Neuroimages: Basal Ganglia Germinoma with Hemiatrophy.

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