Metastatic spinal intramedullary germinoma with elevated cerebrospinal fluid chorionic gonadotropin: a case report.
We treated a patient whose unusual recurrent germinoma illustrates the diagnostic value of measuring human chorionic gonadotropin beta subunit (HCG-beta) in cerebrospinal fluid (CSF) and serum. A 25-year-old man with a suprasellar germinoma and ventricular dissemination was treated successfully with systemic chemotherapy and cranial irradiation. Six years later he developed progressive numbness and weakness in both upper extremities. Magnetic resonance imaging (MRI) disclosed an intramedullary spinal cord tumor in the cervical region. The CSF concentration of HCG-beta was elevated and exceeded that in serum. After completion of systemic chemotherapy and spinal irradiation, symptoms subsided and the tumor was no longer evident on MRI. Based on the patient's history and the rapid response of the tumor to treatment, the spinal cord tumor was considered a metastatic intramedullary spinal germinoma representing CSF dissemination via the central canal.
Kuba
H
H
Department of Neurosurgery, Neurological Institute, Faculty of Medicine, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Japan.
Inamura
T
T
Nishio
S
S
Fukui
M
M
D000328:Adult; D001921:Brain / Q000473:pathology; D018997:Chorionic Gonadotropin, beta Subunit, Human / Q000134:cerebrospinal fluid*; D018237:Germinoma / Q000134:cerebrospinal fluid* / Q000556:secondary* / Q000628:therapy; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D013120:Spinal Cord Neoplasms / Q000134:cerebrospinal fluid* / Q000556:secondary* / Q000628:therapy; D014057:Tomography, X-Ray Computed
D018997:Chorionic Gonadotropin, beta Subunit, Human