Germinoma history and symptoms

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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

Symptoms of germinoma include headache, vomiting, papilledema, lethargy, somnolence, ataxia, behavioral changes, decline in academic performance, paralysis of upward gaze,,paralysis of convergence, diabetes insipidus, delayed pubertal development, precocious puberty, isolated growth hormone deficiency, hypopituitarism (central hypothyroidism, adrenal insufficiency), decreased visual acuity from chiasmic or optic nerve compression, and visual field deficit (e.g, bitemporal hemianopsia). Presenting symptoms of patients with intracranial GCTs depend upon the location, size of the tumor, and the patient's age.

Symptoms

• Presenting symptoms of patients with intracranial GCTs depend upon the location, size of the tumor, and the patient's age.
• Delays in diagnosis of germ cell tumors are common, especially symptoms related to endocrinopathy (diabetes insipidus, delayed vertical growth, etc.) are associated with delays in diagnosis of greater than 12 months, and are associated with higher incidences of disseminated disease.
• In majority of patients with unrecognized CNS GCTs may have had a long history of symptoms such as enuresis, movement disorders, anorexia, and psychiatric complaints. In such cases diagnosis has been delayed from 7 months to 3 years.

The symptoms of CNS germ cell tumors by age are shown below in a tabular form:

Age of the patient	Symptoms of CNS GCT
Prenatal/neonate	Congenital teratomas produce polyhydramnios and hydrocephalus
Young infants	The teratoma and choriocarcinoma subtypes of nongerminoma germ cell tumor are most common in young infants; these patients may present with the following: Irritability Listlessness Failure to thrive Macrocephaly Bulging fontanelle
Beyond infancy	Presentation depends on tumor location

Symptoms of pineal and suprasellar germ cell tumors are shown below in a tabular form:

TYpe of the tumor	Symptoms
Pineal tumors	Pineal tumors typically cause obstructive hydrocephalus In approximately 25 to 50 percent of cases symptoms of increased intracranial pressure are present, which include the following: Headache Vomiting Papilledema Lethargy Somnolence Other symptoms associated with pineal germ cell tumors (GCTs) and obstructive hydrocephalus include the following: Ataxia Behavioral changes Decline in academic performance Neuroopthalmologic abnormalities are present in approximately 50 percent of cases Paralysis of upward gaze Paralysis of convergence Endocrinopathies are rarely associated with pineal tumors, although diabetes insipidus is sometimes observed which may indicate occult tumor involvement of the floor of the fourth ventricle and the suprasellar area
Suprasellar tumors	In majority of cases suprasellar germ cell tumors GCTs are commonly present with hypothalamic/pituitary dysfunctions which include the following: Diabetes insipidus Delayed pubertal development Precocious puberty Isolated growth hormone deficiency Hypopituitarism (central hypothyroidism, adrenal insufficiency) Suprasellar germ cell tumors GCTs can also cause ophthalmologic abnormalities such as: Decreased visual acuity from chiasmic or optic nerve compression Visual field deficit (e.g, bitemporal hemianopsia) In majority of cases patients with suprasellar GCTs have chronic subtle symptoms, and their tumors are diagnosed incidentally on imaging studies performed for unrelated reasons.

References

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