Is Regression of Intracranial Germinoma Spontaneous or Diagnostic Radiation-Induced? A Case Report

Abstract

Although several case reports describing about “spontaneous” regression of primary intracranial germinoma are available, intensive analysis of those reports suggests diagnostic radiation as a possible cause of the regression in those reports. We present a case of regression of intracranial germinoma, which advocates diagnostic radiation as a cause of previously reported regression of intracranial germinoma. A 22-year-old female student was forced to repeat a grade in school due to unusual fatigue. Despite 4-year absence of her menstrual period as a woman of reproductive age, she did not receive medical attention until experiencing unusual fatigue with visual disturbance and undermined learning. Initial endocrinological work-up revealed panhypopituitarism with masked diabetes insipidus. Magnetic resonance imaging showed a suprasellar tumor, involving the neurohypophysis, optic chiasm and hypothalamus, with spinal dissemination. Endoscopic transnasal biopsy provided pathological confirmation of germinoma, which was treated with craniospinal irradiation. Regression of the suprasellar lesion after cranial computed tomography during radiation therapy planning was demonstrated on serial magnetic resonance imaging. The patient obtained remission and regained a nearly normal level of activity under hormone replacement therapy, but restriction of her visual fields did not improve sufficiently. Diagnostic radiation can induce the regression of intracranial germinoma. Clinicians should keep this diagnostic radiation-induced regression of germinoma in mind and should eliminate unnecessary irradiation to germinoma throughout the diagnostic process. Inadvertent diagnostic radiation can hide fine lesions to be treated.




J Neurol Res. 2014;4(1):41-48
doi: http://dx.doi.org/10.14740/jnr264w