A state of art management of a bilateral basal ganglia germinoma: case report

Abstract

Central nervous system germinomas are the most frequent germ cell tumors, predominantly affecting adolescents and young adults. They are generally midline tumors primarily located in the pineal gland and suprasellar regions; however, basal ganglia germinomas (BGGs) are rare and generally unilateral, with only 16 histopathologically-confirmed bilateral BGGs reported to date. In this paper, we are presenting a rare case of bilateral BGG in a 14-year-old boy. The neuroradiological findings of bilateral BGGs are presented, and the strategy for their management is discussed along with previously reported cases. A 14-year-old suffering from involuntary jerky movements of the right shoulder and arm was referred to our department. An MRI scan revealed diffuse T2/FLAIR hyperintensity in the bilateral basal ganglia, and MR spectroscopy suggested a malignant disease. A stereotactic biopsy was conducted, and the histologic examination of the specimen revealed germinoma. Neoadjuvant chemotherapy followed by whole ventricular radiation therapy with a boost to the tumor was initiated. BGGs are mostly unilateral, but rarely bilateral entities may also be seen. Despite excellent survival rates, symptomatic outcomes may not be very favorable. Therefore, it is crucial to recognize the initial MRI findings and diagnose these tumors early for better outcomes and minimal disabilities.