title: Accelerated Unilateral Radiographic Huntingtonian Changes Following Neoadjuvant Chemotherapy for a Nongerminomatous Germ Cell Tumor Leading to Identification of Occult Disease in the Dorsal Striatum.
abstract: Basal ganglia nongerminomatous germ cell tumors comprise 10% to 15% of germ cell tumor and have substantial morbidity at the time of local failure. In this submitted image we present a case where neoadjuvant chemotherapy unmasked a unilateral caudate head loss consistent with Huntingtonian changes. Careful review of the patient's imaging identified disease within the dorsal striatum that was not previously identified at the time of diagnosis. Review of the diffusion tensor fractional anisotropy imaging identified progressive white matter likely secondary to the occult disease within the dorsal striatum. Although this patient was asymptomatic and had no signs of a movement disorder, similar findings have been noted to be a prelude to such findings several months later. The occult disease was incorporated into the patient's radiotherapy planning target volume as oversight of these changes would have led to a marginal miss and potential early disease relapse.
authors.affiliation: *Department of Radiation Oncology, St Jude Children's Research Hospital, Memphis, TN ‡Department of Radiation Oncology §Department of Pediatrics, Division of Pediatric Hematology Oncology †Department of Radiology, Division of Neuroradiology ∥Department of Neurosurgery, Wake Forest Baptist Medical Center, Childress Institute of Pediatrics, Winston Salem, NC.
authors.forename: John T
authors.initials: JT
authors.lastname: Lucas
authors.forename: Michael
authors.initials: M
authors.lastname: Zapadka
authors.forename: Kristin
authors.initials: K
authors.lastname: Houseknecht
authors.forename: Kevin S
authors.initials: KS
authors.lastname: Buckley
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Couture
authors.forename: Doris R
authors.initials: DR
authors.lastname: Brown
mesh_terms: D001932:Brain Neoplasms / Q000150:complications* / Q000188:drug therapy; D017024:Chemotherapy, Adjuvant; D002648:Child; D003342:Corpus Striatum / Q000473:pathology; D038524:Diffusion Magnetic Resonance Imaging; D006801:Humans; D006816:Huntington Disease / Q000150:complications* / Q000175:diagnosis*; D008297:Male; D020360:Neoadjuvant Therapy; D009373:Neoplasms, Germ Cell and Embryonal / Q000150:complications* / Q000188:drug therapy; D059906:Neuroimaging / Q000379:methods