Psychiatric manifestations as initial presentation for pediatric CNS germ cell tumors, a case series.
BACKGROUND
Central nervous system (CNS) germ cell tumors account for 3 % of all pediatric brain tumors in the USA. Presenting symptoms are typically location based with pineal tumors presenting with obstructive hydrocephalus and suprasellar tumors with hypothalamic/pituitary dysfunction and ophthalmologic abnormalities. Psychiatric manifestations such as psychosis and behavioral changes are atypical presentations of CNS germ cell tumors, with only 11 previously reported cases.


METHODS
This is a retrospective case series describing patients with CNS germ cell tumors with an atypical presentation including psychiatric manifestations. Information regarding clinical presentation, treatment course, and outcome were obtained.


RESULTS
We report seven patients who presented with psychiatric symptoms consisting of psychomotor delay as well as behavioral and mood changes. Six of the seven patients were diagnosed ≥6 months after onset of psychiatric symptoms. All of the seven are alive but five continue to have neurologic and psychiatric issues post treatment.


CONCLUSIONS
Atypical presentations of CNS germ cell tumors can delay diagnosis and treatment and may be secondary to atypical locations as well as endocrine dysfunction manifesting as psychiatric symptoms. Delayed diagnosis did not appear to affect survival but earlier diagnosis may potentially be associated with better neurologic and psychiatric outcome. Patients who present with these symptoms and atypical neuroimaging should have a thorough evaluation for CNS germ cell tumors including serum and CSF markers. Clinicians should be aware of these less common presentations to aid in prompt diagnosis and treatment.
Children's Hospital at Montefiore, 3415 Bainbridge Ave, Bronx, NY, 10467, USA. fmalbari@montefiore.org.
F
http://orcid.org/0000-0002-4159-1359
F
Malbari
University of North Carolina School of Medicine, Chapel Hill, NC, USA.
T R
TR
Gershon
NY Presbyterian, Morgan Stanley Children's Hospital, New York, NY, USA.
J H
JH
Garvin
NYU School of Medicine, Hassenfeld Children's Hospital, New York, NY, USA.
J C
JC
Allen
Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Y
Y
Khakoo
Children's Hospital at Montefiore, 3415 Bainbridge Ave, Bronx, NY, 10467, USA.
A S
AS
Levy
Memorial Sloan Kettering Cancer Center, New York, NY, USA.
I J
IJ
Dunkel
D000293:Adolescent; D001932:Brain Neoplasms / Q000150:complications*; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000209:etiology*; D009373:Neoplasms, Germ Cell and Embryonal / Q000150:complications*; D012189:Retrospective Studies; D055815:Young Adult
CNS germ cell tumors; Endocrine dysfunction; Psychiatric