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Panhypopituitarism caused by a suprasellar germinoma: A case report

World Journal of Clinical Cases 2024年第10期12卷 1844-1850页

作者： Jelena Roganovic Lea Saric Silvije Segulja Ana Dordevic Mia Radosevic Department of Pediatrics Clinical Hospital Centre RijekaRijeka 51000Croatia Faculty of Medicine University of RijekaRijeka 51000Croatia Faculty of Health Sciences University of RijekaRijeka 51000Croatia Department of Business Development Jadran Galenski LaboratorijRijeka 51000Croatia

BACKGROUND Suprasellar germinomas are rare intracranial tumors frequently associated with permanent endocrine disorders.We present the clinical picture,treatment,and complications of suprasellar germinoma at pediatric age which,besides being lifethreatening,has lifelong endocrinological consequences.CASE SUMMARY A 12-year-old female patient was presented having had intensive headaches for three weeks and visual disturbances for six months.An ophthalmological examination revealed bilateral papilledema and a marked loss of vision.Emergency brain magnetic resonance imaging(MRI)showed a suprasellar tumor,involving the infundibulum and the optic chiasm,extending to the third ventricle.Laboratory tests confirmed decreased levels of thyroxine,cortisol,gonadotropins,and insulin-like growth factor 1.Maximal tumor reduction was performed,and immunohistopathology established the diagnosis of suprasellar germinoma.MRI of the spine and cerebrospinal fluid cytology confirmed the localized disease.Adjuvant chemotherapy and radiotherapy were performed according to the SIOP CNS GCT II protocol.A post-treatment MRI showed no residual tumor,but pituitary function had not recovered.Three and a half years after the end of the treatment,the patient is in a complete remission,requiring hormonal replacement therapy,continuous education,and psychological support.CONCLUSION This complex case highlights the importance of timely diagnosis,a multidisciplinary approach,and close follow-up in children with suprasellar germinomas.

关键词： germinoma Germ cell tumor Suprasellar tumor Hypopituitarism Management Pediatrics Case report

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Emergency irradiation with 3.4 Gy/2f in sellar/suprasellar germinoma patients with rapid visual acuity decline

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Chinese Medical Journal 2019年第17期132卷 2073-2078页

作者： Bo Li You-Qi Li Chun-De Li Yao Chen Yan-Wei Liu Shuai Liu Xiao-Guang Qin Shi-Qi Luo Department of Radiation Oncology Beijing Tiantan Hospital Capital Medical University Beijing 100070 China Department of Neurosurgery Beijing Tiantan Hospital Capital Medical University Beijing 100070 China Department of Ophthalmology Beijing Tiantan Hospital Capital Medical University Beijing 100070 China

Background: Rapid visual acuity (VA) decline was a common complaint in patients with sellar/suprasellar germinoma. In our hospital, 3.4 Gy/2f of emergency irradiation was applied to save patient VA and enable subsequent chemoradiotherapy. This study aimed to investigate the efficacy of emergency irradiation with 3.4 Gy/2f in patients with sellar/suprasellar germinoma who had rapid VA decline. Methods: From January 2014 to December 2017, 33 patients with sellar/suprasellar germinoma who complained of VA decline within 3 months received 3.4 Gy/2f of emergency irradiation in Beijing Tiantan Hospital. The best-corrected VA (BCVA) and mean deviation (MD) were measured. Correlations between visual function change and clinical factors, including age at diagnosis, duration of VA decline, extent of tumor regression, serum level of tumor markers, were analyzed. Results: Among 33 patients with sellar/suprasellar germinoma, the median diameter and volume of sellar/suprasellar lesions were 32 mm (range: 5–55 mm) and 12.9 cm3 (range 0.6–58.5 cm3), respectively. Data on pre- and post-emergency-irradiation BCVA were obtained in 32 patients. For the right eyes, BCVA was improved in 23 patients (71.9%), unchanged in 7 (21.9%), and worsened in 2 (6.2%);and for the left eyes, these numbers were 27 (84.4%), 4 (12.5%), and 1 (3.1%), respectively. In terms of the logarithm of the minimum angle of resolution (logarithm of the minimum angle of resolution = Log (1/BCVA) score, the improvement was significant in both eyes (P germinoma patients with VA decline, 3.4 Gy/2f of emergency irradiation was effective in improving visual function.

关键词： germinoma Sellar/suprasellar Radiotherapy Chemotherapy Visual acuity Beta-human chorionic gonadotropin

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Diabetes insipidus with impaired vision caused by germinoma and perioptic meningeal seeding:A case report

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World Journal of Clinical Cases 2021年第8期9卷 1976-1982页

作者： Na Yang Hui-Juan Zhu Yong Yao Li-Yun He Yu-Xiu Li Hui You Hua-Bing Zhang Department of Endocrinology Key Laboratory of Endocrinology of National Health CommissionPeking Union Medical College HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100730China Department of Neurosurgery Peking Union Medical College HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100730China Department of Radiology Peking Union Medical College HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100730China

BACKGROUND germinoma is a type of germ cell tumor that most frequently arises in the midline axis of the brain.Impaired vision is a clinical manifestation of germinnoma.Although rare,intracranial germinoma seeding to the perioptic arachnoid space is one cause of visual acuity decrease.CASE SUMMARY An 11yearold girl who presented with polyuria and polydipsia and subsequently developed diminution of vision.Imaging showed bilateral heterogeneous enhancement of the optic nerve sheaths and atrophy of the optic nerve,and transsphenoidal biopsy revealed a germinoma.The patient experienced poor visual recovery following chemotherapy and radiotherapy.germinomas are rare and they are mostly identified in children and adolescents.The manifestations include diabetes insipidus,pituitary dysfunction,visual complaints,etc.The mechanisms that lead to visual loss include intracranial hypertension,compression of optic chiasma,and tumor invasion.A literature review was performed to summarize the cases with a tumor infiltrating the optic nerve.Most of the reported patients were adolescents and presented with anterior pituitary hormone deficiency.Enhancement of optic nerve sheaths and optic disc pallor could be identified in most of the cases.The purpose of this report is to provide awareness that in cases where a germinoma is associated with visual loss,though rare,perioptic meningeal seeding should be taken into consideration.CONCLUSION The case report suggests that children with diabetes insipidus need a complete differential diagnosis.

关键词： germinoma Visual acuity decrease Central diabetes insipidus Perioptic meningeal seeding Intracranial tumor Case report

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Emergency irradiation of 3.4Gy/2f in pineal gland germinoma patients with symptomatic hydrocephalus

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Chinese Neurosurgical Journal 2019年第3期5卷 144-150页

作者： Bo Li Youqi Li Chunde Li Yanwei Liu Shuai Liu Xiaoguang Qiu Shiqi Luo Department of Radiation Oncology Beijing Tiantan HospitalCapital Medical UniversityNo.119 South 4th Ring West RoadFengtai DistrictBeijing 100070China Department of Neurosurgery Beijing Tiantan HospitalCapital Medical UniversityNo.119 South 4th Ring West RoadFengtai DistrictBeijing 100070China

Surgical interventions including ventriculostomy and ventriculo-peritoneal shunt were usually administrated in pineal germ cell tumor patients with symptomatic hydrocephalus. Considering higher sensitivity of germinoma to anti-tumor therapy, we explored emergency irradiation as non-invasive measure in this situation. Methods: Data of 35 germinoma patients with symptomatic hydrocephalus who received emergency irradiation of 3. 4 Gy/2f were studied retrospectively. The maximum width of frontal horn and the minimum width of trunk of corpus cal osum (TCC) were measured to evaluate hydrocephalus changing. Besides, mean deviation (MD) of Humphrey perimetry was employed to evaluate visual field defect. Correlations between hydrocephalus changing and clinical factors, including age, percentage of tumor regression, radiographic re-evaluation interval, and serum beta-human chorionic gonadotropin (β-HCG) level, were analyzed. Results: The median maximum diameter and volume of pineal lesions was 27 mm (range 10–55 mm) and 6.5cm3 (range 0.4–74.1 cm3), respectively. At median 8 days after irradiation, the median percentage of tumor remission was 55% (range 10–100%). The median maximum width of FN and the median minimum width of TCC were 11.6 mm and 39.0 mm, and 8.0 mm and 31.4 mm, before and after irradiation, respectively. The improvement of both parameters reached significant level (p germinoma patients.

关键词： germinoma β-HCG Chemotherapy Radiotherapy Hydrocephalus Visual field defect

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Simultaneous biportal endoscopic management of pineal region tumors in patients with obstructive hydrocephalus:technical notes

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Chinese Neurosurgical Journal 2023年第2期9卷 51-57页

作者： Sultan Al-Saiari Khalid Al Orabi Mohammad Ghazi Abdoh Abdulaziz A.Basurrah Sultan Faez Albalawi Ahmed A.Farag Neurosurgery Department King Abdullah Medical CityP.O 24246MakkahSaudi Arabia

Background The goal of this study is to show the feasibility and benefits of using the simultaneous biportal endoscopic procedure to treat pineal tumors in patients with obstructive hydrocephalus.Methods We retrospectively reviewed three patients with pineal tumors and acute obstructive hydrocephalus who were treated in one session with a frameless stereotactic guided simultaneous biportal endoscopic third ventriculostomy and endoscopic tumor biopsy performed through two separate ports using one rigid ventriculoscope.Results In the three patients,ventriculostomy and endoscopic biopsies were conducted.There was no death or morbidity throughout the 45-min procedure.All of the patients’histological findings were confirmed.germinoma was diagnosed in two patients who recieved postoperative radiotherapy,and the third patient diagnosed with a pineocytoma.Magnetic resonance imaging with flow-sensitive sequences was used to confirm ventriculostomy patency in all patients 6 months after the surgery.Conclusion Biportal endoscopic approach enables better visual control of both procedures.Furthermore,it allows the surgeon to safely pass the ventriculoscope via the foramen of monro,even if it is narrow.Moreover,during endoscopic tumor biopsy and third ventriculostomy,the intracranial pressure can be smoothly managed using the outlet tubes accessible.This treatment may be an alternative to traditional uniportal endoscopic operations in certain patients.

关键词： Pineal tumors germinoma Hydrocephalus Endoscopic third ventriculostomy Endoscopic biopsy

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Intramedullary spinal cord germinoma:a case report

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Chinese Medical Journal 2002年第9期115卷 138-139页

作者：朱建善高玉平郑文均杨玖生 Department of Pathology Renji Hospital Shanghai Second Medical University China.

germinoma is the most common type of germ-cell tumor. Extragonadal germ cell tumors are frequently situated in the midline structures of the body, such as the anterior mediastinum, retroperitoneum, and the brain. Primary intramedullary spinal cord germinoma is very rare. We report a case of primary germinoma originating from the intramedullary portion of the conus medullaris.

关键词： germinoma ·spinal cord intramedullary

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Delayed intra-tumoural haemorrhage in pineal germinoma: Case report and review

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World Journal of Neuroscience 2013年第3期3卷 186-189页

作者： Michael Colditz Craig Winter Kenneth G. Jamieson Department of Neurosurgery Royal Brisbane & Women’s Hospital Herston Australia

Intraparenchymal haemorrhage in a pineal germinoma is a very rare, though clinically significant event. We report the first case of a significantly delayed intraparenchymal haemorrhage in a pineal germinoma, 14 days after endoscopic third ventriculostomy (ETV), causing precipitous patient deterioration. We discuss potential contributing pathophysiological factors, and seek to illustrate that knowledge of its occurrence, and associated morbidity, is clinically significant in managing pineal germinoma patients with acute deterioration post obstructive hydrocephalus CSF diversion.

关键词： Pineal germinoma Haemorrhage Endoscopic Third Ventriculostomy (ETV) Tumour

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Outcome of Vision Impairment and Diabetes Insipidus in Suprasellar Region germinoma

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International Journal of Clinical Medicine 2011年第2期2卷 82-85页

作者： Satoshi Utsuki Hidehiro Oka Yoshiteru Miyajima Chihiro Kijima Kiyotaka Fujii Shinichi Kan 不详

Aim: Many cases of suprasellar region germinoma occurs in diabetes insipidus (DI), but a patient initially may come to the hospital for the chief complaint of visual impairment. The aim of this study is to determine the etiology of initial symptom presentation and the outcomes of visual impairment and DI in suprasellar region germinoma. Methods: We investigated eleven cases of single lesion suprasellar germinomas that were diagnosed and treated in our hospital. For each, a magnetic resonance imaging (MRI) was performed. Results: At the hospital visit, decreased visual acuity was found in 5/11 cases, while DI was found in all cases. The decreased visual acuity was improved in 4/5 cases by treatment, but DI improved in only 2/11 cases. In 10 cases, DI occurred earlier than visual impairment. As the initial symptom, visual impairment occurred earlier than DI in only one case and did not improve by treatment. In this case, a pituitary stalk of the normal thickness could be identified by MRI, and the optic nerve was swollen. In ten cases except this case, no significant enlargement of optic nerve was detected, and a swollen pituitary stalk was confirmed. Conclusions: In suprasellar germinomas, it is rare, but the optic nerve can significantly swell at onset, while the pituitary stalk may be intact. In such cases, visual impairment occurs earlier than DI, and visual impairment may not be improved.

关键词： Diabetes Insipidus Neurohypophyseal germinoma Optic Nerve germinoma Visual Function

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Caution on diagnosis of idiopathetic central diabetes insipidus

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Chinese Medical Journal 2012年第10期125卷 1683-1685页

作者： WANG Xian-ling WANG Ying-qian MU Yi-ming Department of Endocrinology Chinese People's Liberation Army General HospitalBeijing 100853China

Idiopathetic central diabetes insipidus （CDI） is a heterogeneous hypothalamus-pituitary disease due to the absence or deficiency of arginine vasopressin （AVP）.

关键词： central diabetes insipidus germinoma autoimmune hypophysitis pituitary metastase

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Ventriculo-peritoneal shunt trans-anal protrusion causing Escherichia coli ventriculitis in child: Case report and review of the literature

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Chinese Neurosurgical Journal 2017年第1期3卷 59-63页

作者： Yuhan Liu Chunde Li Department of Neurosurgery Beijing TianTanHospital Capital Medical University Beijing 100050 People's Republic of China

Ventriculo-peritoneal shunting is an effective treatment for hydrocephalus, bowel perforation by peritoneal catheters is an extremely rare complications associated with this procedure. We report a 9-year-old girl who had anal VP shunt protrusion two months following surgery and review the literature to understand the diagnosis and treatment for this rare complication. A PubMed search using the keywords 'bowel perforation' and 'Escherichia coli ventriculitis' was performed and citations were reviewed. Neurosurgeons should be alert to early diagnosis and appropriate treatment of this condition to prevent infectious and neurological complications.

关键词： Bowel Perforation germinoma Peritoneal Catheter Shunt Tube Distal Catheter

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