Germinoma involving the basal ganglia in children.
BACKGROUND
Germinoma originating in the basal ganglia is rare, and the majority of reported papers have been from Japan. In a collection of the first 500 cases of primary brain tumors in children in Taipei Veterans General Hospital, six pure germinomas with tissue diagnosis situated in this location.


METHODS
We reviewed the clinical features, neuroimaging studies, tumor markers, management, and outcome of these six patients.


RESULTS
All of them were boys. The median age of onset of symptoms was 9.7 years. They uniformly presented with hemiparesis. The average duration of symptoms before surgical management was 1 year. One patient had bilateral basal ganglia tumors. Serum beta-human chorionic gonadotropin levels was elevated (128 mIU/ml) in one patient. Longitudinal neuroimaging studies in four patients clearly showed that the tumor arose as a tiny lesion at the lenticular nucleus. Five patients had cysts within tumors. Five patients received partial, subtotal, to total resection. One patient had stereotactic biopsy of the tumors. Postoperative primary adjuvant therapies included radiotherapy, chemotherapy alone, and combined chemotherapy and radiotherapy. Five patients survived, and one patient died of radiation-induced sarcoma with median follow-up period of 13.7 years. Local recurrence was observed in all of three patients after solitary postoperative chemotherapy.


CONCLUSIONS
The lenticular nucleus is a significant locus for germinomas and can be bilateral. Although rarely reported in Western countries, it does exist in Taiwan as well. Treatment of germinomas in this specific location is similar to germinoma in other intracranial locations.
Wong
Tai-Tong
TT
Division of Pediatric Neurosurgery, Neurological Institute, Taipei Veterans General Hospital and National Yang Ming University, School of Medicine, No. 210, Sec 2, Shih-Pai, Taipei, Taiwan, 11217, Republic of China. ttwong@vghtpe.gov.tw
Chen
Y W
YW
Guo
Wan-Yuo
WY
Chang
Kai-Ping
KP
Ho
Donald M
DM
Yen
Sang-Hue
SH
D000293:Adolescent; D001479:Basal Ganglia / Q000473:pathology*; D014408:Biomarkers, Tumor / Q000097:blood; D001932:Brain Neoplasms / Q000097:blood / Q000473:pathology* / Q000628:therapy; D002648:Child; D018997:Chorionic Gonadotropin, beta Subunit, Human / Q000097:blood; D003342:Corpus Striatum / Q000473:pathology; D018237:Germinoma / Q000097:blood / Q000175:diagnosis / Q000473:pathology* / Q000628:therapy; D006801:Humans; D008297:Male; D009364:Neoplasm Recurrence, Local; D010870:Pineal Gland / Q000473:pathology; D012189:Retrospective Studies; D013624:Taiwan
D014408:Biomarkers, Tumor; D018997:Chorionic Gonadotropin, beta Subunit, Human