Ann Clin Neurophysiol.  2020 Oct;22(2):109-111. 10.14253/acn.2020.22.2.109.

Delayed diagnosis of intramedullary spinal cord germinoma

• Kim H
• Lee EJ
• Sung JJ

• KMID: 2511086
• DOI: http://doi.org/10.14253/acn.2020.22.2.109

Abstract

Germ-cell tumors (GCTs) are common in the central nervous system. GCTs are highly sensitive to radiotherapy and chemotherapy and can be cured without radical surgery. However, this tumor produces nonspecific imaging findings, and its rarity can make diagnosis challenging. Here we report a case in which the first diagnosis was uncertain and follow-up imaging revealed intramedullary germinoma. The patient underwent chemotherapy and radiotherapy after the diagnosis.

Keyword

Germ-cell tumor; Germinoma; Spinal cord neoplasms

Figure

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  Fig. 1. Clinical and radiological features of the patient. Weakness was evident in the lower extremities. Magnetic resonance imaging (MRI) performed in December 2014 showed no abnormality in T2-weighted sagittal (A) and axial (B) images. Follow-up spinal MRI revealed fusiform swelling at levels T12-L1 (arrows) in sagittal unenhanced T1-weighted (C), T2-weighted (D), and gadolinium-enhanced T1-weighted (E) MRI images, with minimal homogeneous enhancement.

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  Fig. 2. Representative images of the surgical specimen. (A) Large epithelioid cells with abundant clear cytoplasm, round nuclei, and prominent nucleoli were evident (hematoxylin-eosin, ×400). (B, C) Ancillary immunostaining revealed strong membrane positivity for placental alkaline phosphatase (B) and CD117 (c-kit; C) in the tumor cells (×400). (D) A grayish purple mass was found intraoperatively. There was no definite dissection plane between the spinal cord and the mass.

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