Primary diffuse chiasmatic germinomas: differentiation from optic chiasm gliomas.

Abstract:

:Primary germ cell tumors confined to the optic nerves and chiasm without suprasellar extension are uncommon. These tumors appear similar to chiasmatic gliomas on both computed tomography and magnetic resonance imaging, potentially resulting in treatment errors if the diagnosis is based on radiologic criteria alone. Unlike chiasmatic gliomas, suprasellar germinomas characteristically present with a clinical triad of endocrine abnormalities, diabetes insipidus, and visual complaints. We report the case of a 9-year-old boy who presented with a 5-month history of fatigue, 16-pound weight gain, polydipsia, polyuria, visual complaints, and intermittent headache. Imaging studies demonstrated findings consistent with a glioma of the chiasm with infiltration into the optic tracts. At surgery, the chiasm and optic tracts were diffusely enlarged with no other suprasellar abnormalities. Biopsy specimens were characteristic of germ cell tumor. Based on this result, the patient received a treatment regimen different from that used at our institution for chiasmatic gliomas. We feel it is imperative to biopsy chiasmatic lesions that radiologically appear to be gliomas if symptoms do not adhere to the classical clinical presentation.

journal_name

Pediatr Neurosurg

journal_title

Pediatric neurosurgery

authors

Wilson JT,Wald SL,Aitken PA,Mastromateo J,Vieco PT

doi

10.1159/000120927

subject

Has Abstract

pub_date

1995-01-01 00:00:00

pages

1-5; discussion 6

issue

1

eissn

1016-2291

issn

1423-0305

journal_volume

23

pub_type

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