A Rare Case of Primary CNS Germinoma in the Pineal Region with Long-standing Hearing Loss

Abstract

Germinomas in the brain are rare neoplasms which make up less than 1% of all intracranial tumors. Their clinical presentation is usually related to the increased intracranial pressure and/or hydrocephalus. This report describes a case who presented to our hospital for headaches and visual changes, including Parinaud's syndrome, that had started recently. The patient also had been complaining of chronic bilateral hearing loss for several years which seemed not properly evaluated previously. MRI brain showed a markedly enhancing lesion in the pineal region. CSF and serum tumor markers including B-human chorionic gonadotropin (B-HCG) and alfa-fetoprotein (AFP) were normal. Lumbar puncture with cytology was negative for malignancy. Biopsy was taken from the mass and sent to the pathology lab for testing. Histopathological examination showed changes consistent with germinoma and the immunohistochemical staining including that for placental alkaline phosphatase (PLAP) confirmed the diagnosis. There was no evidence of metastasis and the patient was treated with radiation-alone therapy that resulted in marked regression of the mass and significant clinical improvement except for the issue of hearing loss which had persisted, as expected, given its long-standing existance. In addition to highlighting the diagnostic evaluation and treatment approach for such rare tumors, this case suggests considering pineal germinomas among the differential diagnosis when dealing with hearing loss which needs careful evaluation and should never be underestimated.