title: Sellar and suprasellar mixed germ cell tumor mimicking a pituitary adenoma.
abstract: Germ cell tumors (GCT) are a heterogeneous group of lesions whose origin is not well established. Several cases of primary intrasellar germinomas have been reported, however non-germinomatous GCT have rarely been described. We report the case of a young adult male patient with a mixed GCT that presented with a sellar tumor with suprasellar extension. The patient seeked medical attention because of seizures and magnetic resonance imaging evidenced a tumor of the sellar region. Hyperprolactinemia was also present and dopamine agonist therapy was started. As there was a rapid tumor growth and the patient had concomitant central diabetes insipidus and elevated testosterone levels, a GCT was suspected and confirmed by elevated serum concentration of β-human chorionic gonadotrophin. Patient underwent surgical resection of the tumor and histopathological examination confirmed the diagnosis of a mixed GCT. Chemotherapy was initiated, followed by conventional radiotherapy. In conclusion, although pituitary adenomas respond for the vast majority of sellar tumors, concomitant symptoms such as central diabetes insipidus and rapid tumor growth should raise the suspicion of a diverse diagnosis. The present report intend not only to show a rare case of sellar and suprasellar mixed GCT but also to remind clinicians that if laboratory findings do not fit into patient's diagnosis (such as high testosterone levels in our patient), then the diagnosis should be reviewed.
authors.affiliation: Endocrinology Unit, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil. lwildemberg@hotmail.com
authors.forename: Luiz Eduardo Armondi
authors.initials: LE
authors.lastname: Wildemberg
authors.forename: Leonardo
authors.initials: L
authors.lastname: Vieira Neto
authors.forename: Giselle Fernandes
authors.initials: GF
authors.lastname: Taboada
authors.forename: Aline Barbosa
authors.initials: AB
authors.lastname: Moraes
authors.forename: Jorge
authors.initials: J
authors.lastname: Marcondes
authors.forename: Flávia Lúcia
authors.initials: FL
authors.lastname: Conceição
authors.forename: Leila
authors.initials: L
authors.lastname: Chimelli
authors.forename: Mônica Roberto
authors.initials: MR
authors.lastname: Gadelha
mesh_terms: D000236:Adenoma / Q000175:diagnosis* / Q000473:pathology; D000328:Adult; D003937:Diagnosis, Differential; D006801:Humans; D008297:Male; D018198:Mixed Tumor, Malignant / Q000175:diagnosis* / Q000473:pathology; D009373:Neoplasms, Germ Cell and Embryonal / Q000175:diagnosis* / Q000473:pathology; D010911:Pituitary Neoplasms / Q000175:diagnosis* / Q000473:pathology; D012658:Sella Turcica / Q000473:pathology*