Radiology Quiz 17966 | Radiopaedia.org

Images
Questions
Findings

What are the most common locations for intracranial germinomas?

Pineal gland (80 - 90%); suprasellar mass (50%); paraventricular parts of the basal ganglia and thalamus (5 - 10%)

When arising in the suprasellar location what is the usual clinical presentation due to?

Diabetes insipidus is the most common presentation for suprasellar germinomas. Hypogonadism or other hypopituitarism is also common. Signs of mass effect (chiasmatic compression, headaches) are present in ~50% of cases.

The patient went on to have an endoscopic transphenoidal biopsy.

Histology

MICROSCOPIC DESCRIPTION: The sections show fragments of unremarkable anterior pituitary tissue and fragments of loosely aggregated tissue which is densely infiltrated by small lymphoid cells and scattered eosinophils. In several fragments there is also a population of atypical large cells with round, oval and reniform nuclei, some with prominent nucleoli and a variable amount of pale cytoplasm. These cells are intimally mixed with the small lymphoid cells. An occasional mitotic figure is identified in the large cells.

Immunohistochemistry shows strong staining in the atypical large cells for c-kit (CD117) in a membrane and Golgi pattern. Scattered large cells also show moderate staining for CD30 and weak staining for placental alkaline phosphatase (PLAP). The small lymphoid cells are predominantly CD3+ T lymphocytes with lesser numbers of CD20+/CD79a+ B lymphocytes. There is positive S-100 immunostaining in several fragments consistent with background posterior pituitary tissue. No staining for CD1a is seen. No trophoblastic component is identified.

DIAGNOSIS: germinoma