Neurohypophyseal germinoma with metastasis to the spine

Abstract

Germ cell tumours constitute 0.1–3.4% of all intracranial tumours and germinomas are malignant intracranial germ cell tumours with a peak incidence in children and adolescents. The pineal gland is the most common site of origin constituting about 50%, followed by the suprasellar region (20–30%). Suprasellar and pineal region germinomas account for approximately 6–10% of intracranial germ cell tumours. There were numerous reports which correlated pathological and imaging findings of suprasellar germinomas and concluded that these tumours involve the hypothalamo-neurohypophyseal axis (hypothalamus, infundibulum and posterior lobe of the pituitary gland). On the basis of these findings, suprasellar germinoma is also called neurohypophyseal germinoma. Germinomas spread readily through the subarachnoid space and involve the spinal meninges and infiltrate directly into the surrounding structures. Intracranial germinomas are highly susceptible to irradiation and chemotherapy and are potentially curable. Therefore we hope to highlight the importance of differentiating germinoma from other midline sellar-suprasellar intracranial tumours and one should be more diligent in looking for possible spinal dissemination at presentation and during follow-up.