Brain Tumor Res Treat.  2018 Oct;6(2):73-77. 10.14791/btrt.2018.6.e9.

Pineal and Suprasellar Germinoma Cooccurence with Vertebra Plana: A Case Report

• Seilanian Toosi F
• Aminzadeh
• Faraji Rad M
• Nekooei S
• Nahidi M
• Keykhosravi E

• KMID: 2423977
• DOI: http://doi.org/10.14791/btrt.2018.6.e9

Abstract

Germinoma is the most common type of intracranial germ cell tumors (GCTs). Pineal gland and suprasellar region are the most frequent sites of central nervous system (CNS) involvement. Intracranial masses caused by Langerhans cell histiocytosis (LCH) mimics features of CNS GCTs. LCH frequently involve spine and is the most common cause of vertebra plana in children. A 15-year-old boy presented with progressing symptoms of polydipsia, polyuria, general headache, nausea and severe back pain. Brain MRI showed brain tumor with simultaneous involvement of suprasellar region and pineal gland. An excisional biopsy of suprasellar mass was done. The pathologic assessment confirmed the diagnosis of germinoma. Patient's treatment continued accordingly. A spine MRI, done due to persistent backache, showed a vertebra plana. We reevaluated the primary diagnosis suspecting LCH. Germinoma of CNS was confirmed and a biopsy of vertebral lesion resulted in hemangioma. Thus we report a case of CNS germinoma with co-occurrence of vertebra plana. We emphasized the importance of histopathologic diagnosis of pineal/suprasellar masses and primary investigation of other CNS regions including spine for possible metastasis or comorbidities.

Keyword

Germinoma; Langerhans cell histiocytosis; Vertebra; Hemangioma

MeSH Terms

Adolescent
Back Pain
Biopsy
Brain
Brain Neoplasms
Central Nervous System
Child
Comorbidity
Diagnosis
Germinoma*
Headache
Hemangioma
Histiocytosis, Langerhans-Cell
Humans
Magnetic Resonance Imaging
Male
Nausea
Neoplasm Metastasis
Neoplasms, Germ Cell and Embryonal
Pineal Gland
Polydipsia
Polyuria
Spine*

Figure

• 

  Fig. 1 Sagittal T1-weighted (A) and T2-weighted (B) images show two complex solid-cystic masses, a 17 mm mass located in pineal region and a 15 mm mass in suprasellar region.

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  Fig. 2 Sagital (A), axial (B and D), and coronal (C) post contrast T1-weighted images show enhancement in solid parts in both masses.

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  Fig. 3 Sagital T2-weighted (A) and T1-weighted (B) images shows complete collapse of T5 vertebral body (vertebra plana) with preservation of disk space. Moderate spinal cord compression is seen.

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