Multicentric intracranial germinomas – Case report

Intracranial germ cell tumors, in locations other than the suprasellar and pineal area, are rare and typically present in children and adolescents. There is a dearth of literature regarding the presentation and treatment of germ cell tumors, particularly in adults. We present the case history, management, and 2-year follow up imaging of a 33-year-old male presenting with headaches and diabetes insipidus. On investigation, multiple tumors were found in the pineal, sellar region, posterior falcine area, and the frontal lobe on enhanced MRI. Stereotactic biopsy of the most accessible lesion was performed. Immunological analysis revealed tumor cells positive for OCT 3/4, CD117, CD10, D2-40 and dot-like CAM5.2. The patient was treated with BEP (Bleomycin + Etoposide + Cisplatin) chemotherapy and cranio-spinal proton beam radiation with significant reduction of tumor burden and no local recurrence or distant metastasis at 24 months. Timely diagnosis and excellent response to chemo-radiation helped avoid invasive and morbid surgical interventions. This case enhances the understanding of timely diagnosis and initiation of treatment for central nervous system germ cell tumors. • This case highlights the diagnostic dilemma that the clinical and radiological findings can present. in rare central nervous system germ cell tumors. • Usually occurring in children and adolescents, in this case, the patient was in his third decade of life. • Timely diagnosis and excellent response to chemo-radiation helped avoid invasive and morbid surgical interventions