Germinoma with diffuse subependymal quadriventricular, cerebellar, and rostral brainstem spread

Abstract

Introduction. Germinoma of the central nervous system have a predilection for the midline, the differential diagnosis is broad, immunohistochemistry determines the definitive diagnosis.

Clinical case. A 19-year-old male begins with double vision when staring or following objects, bilateral frontal headache, without radiation, stabbing. Decreased visual acuity was added, with third cranial nerve palsy to conjugated gaze supraversion, absent Babinski, intention tremor, ataxic gait to TANDEM and dizziness when performing it. Upon admission; clinical diagnosis, cerebellar verm syndrome; imaging diagnosis, likely primary brain lymphoma and non-communicating hydrocephalus; surgical management, placement of the right precoronal point, ventriculo-peritoneal shunt valve, and sampling of cerebrospinal fluid; tumor markers, negative; pharmacological management, ceftriaxone and albendazole; incisional biopsy due to left parietal stereotactic surgery, intraoperative biopsy, lymphoid atypia; histopathological diagnosis, neoplastic lesion; immunohistochemical diagnosis, germinoma.

Conclusion. This is the first described case of a midline germinoma with diffuse subependymal quadriventricular, cerebellar and rostral brain stem spread.