Das primäre intrakranielle Germinom Probleme der Diagnosefindung am Beispiel von vier Fällen

Zusammenfassung.

Primäre intrakranielle Germinome sind eine mögliche Ursache eines „idiopathischen” Diabetes insipidus im Kindes- und Jugendalter. Histopathologisch können sie entzündlichen Veränderungen ähneln, was zu einer Verzögerung in der Diagnosefindung führen kann. Anhand der Anamnese sowie klinischer und radiologischer Befunde von vier Patienten mit einem histologisch gesicherten, primär intrakraniellen Germinom werden weitere Probleme in der Diagnosefindung aufgezeigt.

Primary intracranial Germinoma - diagnostic difficulties demonstrated in four cases.

Primary intracranial germinoma is a possible cause of “idiopathic” diabetes insipidus in childhood and adolescence. The histopathologic appearance can be similar to inflammation, and may delay the final diagnosis. Further diagnostic difficulties are demonstrated by the use of anamnestic and clinical data as well as diagnostic imaging findings in four children with histologically proven primary intracranial germinoma.

Schlüsselwörter:

Primäre intrakranielle Germinome - Neurohypophysitis - Kindes- und Jugendalter - Magnetresonanztomographie

Key words:

Primary intracranial germinoma - Neurohypophysitis - Childhood and adolescence - Magnetic resonance imaging

Literatur

• 1 Bjornsson J, Scheithauer B W, Okazaki H, Leech R W. Intracranial germ cell tumors. Pathobiological and immunohistochemical aspects of 70 cases.  J Neuropathol Exp Neurol. 1985;  44 32-46
• 2 Göbel U, Calaminus G, Harms D. Keimzelltumoren bei Kindern und Jugendlichen.  Praxis. 1995;  39 1063-1067
• 3 Zulch K J. Histological typing of tumors of the central nervous system.  Geneva; World Health Organization 1979
• 4 Kleihues P C, Burger P C, Scheithauer B W. Histological typing of tumor of the central nervous system In: Scheithauer BW (Hersg.):. WHO international histology classification of tumors. (2nd edition). Springer; 1993
• 5 Jellinger K. Primary intracranial germ cell tumors.  Acta Neuropathol. 1973;  25 291-306
• 6 Hoffmann H J, Otsubo H, Hendrick E B, Humphreys R P, Drake J M, Becker L E, Greenberg M, Jekin D. Intracranial germ cell tumors in children.  J Neurosurg. 1991;  74 545-551
• 7 Waga S, Handa H, Yamashita J. Intracranial germinomas: treatment and results.  Surg Neurol. 1979;  11 167-172
• 8 Kim D I, Yoon P H, Ryu Y H, Jeon P, Hwang G J. MRI of germinomas arising from the basal ganglia and thalamus.  Neuroradiology. 1998;  4 507-5011
• 9 Allen J C, Hokim J, Packer R J. Neoadjuvent chemotherapy for newly diagnosed germ cell tumors of the central nervous system.  J Neurosurg. 1987;  67 65-70
• 10 Matsutani M, Sano K, Takakura K, Fujimaki T, Nakamura O, Funata N, Steo T. Primary intracranial germ cell tumors: a clinical analysis of 153 histologically verified cases.  J Neurosurg. 1997;  86 446-455
• 11 Salzmann K L, Rojiani A M, Buatti J, Quisling R G, Marcus RB J r., Maria B L, Mickle J P, Kedar A. Primary intracranial germ cell tumors: clinicopathologic review of 32 cases.  Pediatr Pathol Lab Med. 1997;  17 13-27
• 12 Göbel U, Calamius G. SIOP CNS GCT 96 (protocol for diagnosis, documentation and treatment). International Coordinator and Registration Center Calaminus G. Düsseldorf; 1996
• 13 Ono N, Kakegawa T, Zama A, Nakamura M, Inoue H K, Tamura M. Suprasellar germinomas; relationship between tumor size and diabetes insipidus.  Acta Neurochir. 1992;  114 26-32
• 14 Sherwood M C, Stanhope R, Preece M A, Grant D B. Diabetes insipidus and occult intracranial tumors.  Arch Dis Child. 1986;  61 1222-1235
• 15 Bettendorf M, Fehn M, Grulich-Henn J, Selle B, Drage K, Ludecke D K, Heinrich U, Saeger W. Lymphocytic hypophysitis with central diabetes insipidus and consequent panhypopituitarism preceding a multifocal, intracranial germinoma in a prepubertal girl.  Eur J Pediatr. 1999;  158 288-292
• 16 Leger J, Velasquez A, Garel C, Hassan M, Czernichow P. Thickened Pituitary stalk on magnetic resonance imaging in children with central diabetes insipidus.  J Clin Endocrinol Metab. 1999;  84 1954-1960
• 17 Mootha S L, Barkovic A J, Grumbach M M, Edwards M S, Gitelman S E, Kaplan S L, Conte F A. Idiopathic hypothalamic diabetes insipidus, pituitary stalk thickening, and the occult intracranial germinoma in children and adolescents.  J Clin Endocrinol Metab. 1997;  82 1362-1367
• 18 Ramelli GR von der Weid N, Stanga Z, Mullis P E, Buergi U. Suprasellar germinomas in childhood and adolescence: diagnostic pitfalls.  J Pediatr Endocrinol Metab. 1998;  11 693-697
• 19 Nitta T, Hishii M, Sato K, Okumura K. Immunohistochemical characterization of “small, lymphoid-like cell populations” within germinomas': immunohistologic and molecular approaches to diagnosis.  Cancer Lett. 1995;  90 183-189
• 20 Imura H, Nakao K, Shimatsu A, Ogawa Y, Sando T, Fujisawa I, Yamabe H. Lymphocytic infundibuloneurohypophysitis as a cause of central diabetes insipidus.  N Engl J Med. 1993;  329 683-689
• 21 Thodou E, Asa S IL, Kontogeorgos G, Kovacs K, Horvath E, Ezzat S. Clinical case seminar: lymphocytic hypophysitis: clinicopathological findings.  J Clin Endocrinol Metab. 1995;  80 2302-2311
• 22 Alifdal M, El Abbadi N, Maftah M, Banani A, Benjaafar N, Bellakhd F. Double localisation d'un germinome intracrânien.  Neurochirurgie. 1995;  41 424-428
• 23 Nakagawa K, Aoki Y, Akanuma A, Salkata K, Terahara A, Onogi Y, Hasezawa K, Muta N, Sasaki Y. Radiation therapy of intracranial germ cell tumors with radiosensitivity assessment.  Radiat Med. 1992;  10 55-61
• 24 Akai T, lizuka H, Kadoya S, Noijma T. Extraneural metastasis of intracranial germinoma with syncytiotrophoblastic giant cells - case report.  Neurol Med Chir (Tokyo). 1998;  38 574-577
• 25 Sumida M, Uozumi T, Kiya K, Mukada K, Arita K, Kurisu K, Sugiyama K, Onda J, Satoh H, lkawa F, Migita K. MRI of intracranial germ cell tumors.  Neuroradiology. 1995;  37 32-37
• 26 Moon W K, Chang K H, Han M H, Kim I O. Intracranial germinomas: correlation of imaging findings with tumor response to radiation therapy.  AJR. 1999;  172 713-716
• 27 Suzuki K, Sonobe M, Matsutani M, Sugita K, Takahashi S. Suprasellar cystic germinoma.  Childs Nerv Syst. 1999;  15 134-136