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Case No. 231
2010-12-16~2011-01-02
출제자 : 관리자
Hit : 499
| Period | 2010-12-16~2011-01-02 |
|---|---|
| Diagnosis | |
| Clinical information | M/17 C.C.: Headache and diplopia |
| Discussion | 정답: Germinoma 설명: Precontrast CT에서 left basal ganglia에 high density의 mass가 있으며 multifocal low density area가 내부에 보이고 일부는 hemorrhage로 생각되는 fluid-fluid level을 보이며 high density area는 enhancement를 보임. Axial T2WI에서 동일한 부위에 multicystic mass가 있고 hemorrhage가 동반되어 있으며 hemorrhage가 없는 부분은 enhancement를 보임. Tumor주변으로 edema는 심하지 않음. 고찰: Germinomas are the most common and least malignant intracranial germ cell tumor, usually found in the pineal and suprasellar region. Intracranial germinomas are thought to arise from a midline stream of totipotential cells very early in the period of rostral neural tube development. However, development of the third ventricle may cause deviation of ectopic germ cells from the midline, and the cells may appear in the basal ganglia and thalamus. Primary thalamic and basal ganglia germinoma, also called ectopic germinoma, have been described in the literature, occurring in 5% to 10% of all intracranial germinomas, and they are more common in Asian populations. Typical neuroimaging appearance was that of a hyperdense lesion in the basal ganglia on unenhanced head CT and heterogeneous high signal intensity on T2-weighted images. The signal intensity of the parenchymal germinomas was heterogeneous on spin-echo images due to hemorrhage, multiple cysts and solid components. There was enhancement after administration of gadolinium in solid component and associated ipsilateral cerebral and brain stem hemiatrophy, representing Wallerian degeneration. Hemiatrophy and Wallerian degeneration are found in 33% of the cases, according to the literature. 참고문헌: 1. Kim DI, Yoon PH, Ryu YH, Jeon P, Hwang GJ. MRI of germinomas arising from the basal ganglia and thalamus. Neuroradiology 1998; 40:507-511. 2. Moon WK, Chang KH, Kim IO, et al. Germinomas of the basal ganglia and thalamus: MR findings and a comparison between MR and CT. AJR Am J Roentgenol 1994; 162:1413-1417. 3. Sakai K, Shigeta H. Serial MR and CT features of primary germinoma originating in the basal ganglia. J Clin Neurosci 1999; 6:162-164. 4. Wong TT, Chen YW, Guo WY, Chang KP, Ho DM, Yen SH. Germinoma involving the basal ganglia in children. Childs Nerv Syst 2008; 24:71-78. |
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