title: A rare case of multifocal intramedullary germinoma in cervical spinal cord.
abstract: METHODS
  Case report.
  
  
  OBJECTIVE
  We present for the first time a patient with multifocal intramedullary cervical spinal cord germ cell tumors with elevated serum alpha-fetoprotein (AFP).
  
  
  METHODS
  Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China.
  
  
  METHODS
  A 19-year-old girl experienced numbness in her right leg 10 months before diagnosis. The numbness gradually became severe and extended up to the thorax. Magnetic resonance imaging (MRI) visualized several intramedullary masses with intensive enhancement and extensive peritumoral edema in the spinal cord at the C3-T1 vertebral body levels. Administration of methylprednisolone caused no treatment effect. The largest mass, which was located at the T1 level inside the normal spinal cord and confirmed by naked eye observation, was completely extracted under a microscope. Postoperative pathological examination demonstrated the so-called 'two-cell pattern,' which is typical of germinoma with placental alkaline phosphatase expression. The serum level of AFP was 64.50 ng ml(-1) (normal range: 0-5 ng ml(-1)). The residual tumor was eliminated through radiation therapy (local 30 Gy) following surgery. Afterward, the patient's neurological deficits were improved but not resolved.
  
  
  RESULTS
  Six years after surgery, no recurrence was encountered and the patient remained stable.
  
  
  CONCLUSIONS
  Radiotherapy is the salvage therapy for spinal cord germinoma. Steroids were of no therapeutic value in the treatment of intramedullary spinal cord germinoma.
authors.affiliation: Department of Neurosurgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China.
authors.forename: R
authors.initials: R
authors.lastname: Wang
authors.affiliation: Department of Pathology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China.
authors.forename: X
authors.initials: X
authors.lastname: Fan
authors.affiliation: Department of Radiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China.
authors.forename: B
authors.initials: B
authors.lastname: Zhang
mesh_terms: D066193:Cervical Cord / Q000473:pathology; D005260:Female; D018237:Germinoma / Q000097:blood / Q000188:drug therapy; D006801:Humans; D008279:Magnetic Resonance Imaging; D008775:Methylprednisolone / Q000627:therapeutic use; D018696:Neuroprotective Agents / Q000627:therapeutic use; D013120:Spinal Cord Neoplasms / Q000097:blood / Q000188:drug therapy; D055815:Young Adult; D000509:alpha-Fetoproteins / Q000378:metabolism
chemical_list: D018696:Neuroprotective Agents; D000509:alpha-Fetoproteins; D008775:Methylprednisolone