학술논문
Early diagnosis in a case of atypically located germinoma: 1 H-MR-spectroscopy as a decision tool.
Document Type
Report
Author
Steidl E; Department of Radiology, University Hospital Bonn, Germany.; Zschernack V; Department of Neuropathology, University Hospital Bonn, Germany.; Träber F; Department of Radiology, University Hospital Bonn, Germany.; Schäfer N; Department of Neurology, University Hospital Bonn, Germany.
Source
Publisher: Published by Oxford University Press and JSCR Publishing Ltd Country of Publication: England NLM ID: 101642070 Publication Model: eCollection Cited Medium: Print ISSN: 2053-8855 (Print) Linking ISSN: 20538855 NLM ISO Abbreviation: Oxf Med Case Reports Subsets: PubMed not MEDLINE
Subject
Language
English
ISSN
2053-8855
Abstract
CNS germinoma is a malignant germ cell tumor with a high potential for curative treatment. In MRI it mainly appears as contrast enhancing mass in the midline structures of the brain but it can also occur atypically located in the basal ganglia. We present the case of a 21-year-old patient suffering from psychiatric symptoms and a mild, right-sided hemiparesis. A MRI scan solely showed diffuse T2/FLAIR hyperintensity and mild atrophy around the left basal ganglia. As excessive diagnostics remained insignificant, 1 H-MR-spectroscopy was performed. Considering the previous diagnostics, increased choline, decreased NAA and increased Myoinositol suggested a malignant disease. Consequently, brain biopsy was performed, revealing a germinoma. In comparable, published cases a lack of evidence for a neoplastic disease usually leads to a severely delayed diagnosis. Our report shows for the first time, that this evidence can be obtained early with MR-spectroscopy and discusses the possibility of specific metabolic patterns.