Abstract
BACKGROUNDCraniopharyngiomas and germ cell tumors (GCTs) are both rare intracranial tumors commonly present in childhood or middle age. They share similar clinical and radiological features. GCTs commonly give rise to tumor markers in the cerebrospinal fluid, hence guiding the treatment plan.OBSERVATIONSThis article reports the case of a 5-year-old boy with a large sellar and suprasellar mass with obstructive hydrocephalus. Laboratory studies showed increased beta-human chorionic gonadotrophin (β-hCG) levels in the cystic fluid, suggestive of choriocarcinoma. He underwent 3 cycles of chemotherapy but showed a poor response. Further aspiration followed by tumor debulking was performed, and histopathological examination revealed craniopharyngioma.LESSONSThis case report indicates that β-hCG, commonly regarded as a specific tumor marker for choriocarcinoma, is detectable in other forms of suprasellar tumors. The authors highlight clinical and radiological features of suprasellar tumors that can be misdiagnosed as intracranial GCTs. The relevance of tumor markers and indications for histopathological confirmation are discussed.
Highlights
Craniopharyngiomas and germ cell tumors (GCTs) are both rare intracranial tumors commonly present in childhood or middle age
Given persistent raised intracranial pressure (ICP) symptoms despite cerebrospinal fluid (CSF) diversion surgery 2 weeks earlier, an Ommaya shunt was inserted during image-guided surgery to decompress the cystic component of the tumor
Observations Diagnosis of intracranial germ cell tumor (ICGCT) depends on the clinical condition of the patient and a midline intracranial tumor combined with increased levels of tumor markers such as β-hCG and αFP in the serum and CSF.[6,8,12] αFP is a marker for tumors with yolk sac components, whereas β-hCG is commonly expressed by choriocarcinomas, malignant teratomas, and embryonal carcinomas containing trophoblastic tissue.[4] hCG is physiologically produced by placental syncytiotrophoblasts of the placenta to maintain pregnancy,[5,8] it is not a specific placental hormone and can be found in trophoblast-derived lesions present in germinoma tissue.[5,8,9]
Summary
Craniopharyngiomas and germ cell tumors (GCTs) are both rare intracranial tumors commonly present in childhood or middle age. They share similar clinical and radiological features. Laboratory studies showed increased beta-human chorionic gonadotrophin (β-hCG) levels in the cystic fluid, suggestive of choriocarcinoma. He underwent 3 cycles of chemotherapy but showed a poor response. Intracranial germ cell tumor (ICGCT) affects the suprasellar region, leading to identical clinical manifestations. Distinctions between craniopharyngiomas and other intracranial cystic lesions can be difficult
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