Germinoma physical examination

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Simrat Sarai, M.D. [2]

Overview

Common physical examination findings of germinoma include paralysis of upward gaze, pupils nonreactive to light perception and accommodation or pupils which react better to accommodation than light, nystagmus, failure of convergence, lid retraction, papilledema, ataxia, and neurologic examination may be abnormal depending on the location of the tumor.

Physical Examination

The clinical evaluation for germ cell tumors should include the following:

• General physical examination
• Check of growth parameters
• Careful neurological evaluation
• Assessment of primary and secondary sexual characteristics
• Ophthalmological exam

Radiographic characteristics of CNS germ cell tumors GCTs cannot reliably differentiate germinomas from nongerminomatous germ cell tumors NGGCTs. The diagnosis of GCTs is based on the following:

• Clinical signs and symptoms
• Tumor markers (Alpha-fetoprotein (AFP) and beta subunit human chorionic gonadotropin (beta-HCG) in both serum and CSF, lumbar CSF cytology)
• Neuroimaging
• Cytological cerebrospinal fluid (CSF) and histological confirmation
• Magnetic resonance imaging (MRI) of brain and spine with gadolinium
• Evaluation of pituitary/hypothalamic function
• Visual-field examinations for suprasellar or hypothalamic tumors
• A baseline neuropsychological examination when symptoms of endocrine deficiency and raised intracranial pressure are resolved

HEENT

• Paralysis of upward gaze
• Pupils nonreactive to light perception and accommodation or pupils which react better to accommodation than light
• Nystagmus
• Failure of convergence
• Lid retraction
• Visual-field examinations
• Papilledema
• A baseline neuropsychological examination is also performed

Neuromuscular

• Patient is usually oriented to persons, place, and time: However, altered mental status may be present if there is increased intracranial pressure
• Clonus may be present
• Hyperreflexia / hyporeflexia / areflexia
• Positive Babinski / plantar reflex unilaterally/bilaterally
• Proximal/distal muscle weakness unilaterally/bilaterally
• Paralysis of upward gaze, failure of convergence, and pupils nonreactive to light perception and accommodation suggestive of cranial nerve II and III deficit
• Unilateral/bilateral upper/lower extremity weakness
• Unilateral/bilateral sensory loss in the upper/lower extremity
• Ataxia
• Normal finger-to-nose test / Dysmetria
• Dysdiadochokinesia

References

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