Suprasellar germinoma and late perioptic seeding

To report an unusual case of optic nerve seeding 12 years following treatment of a suprasellar germinoma. Observational case report. A 34-year-old woman presented with a 3-week history of subjective right eye visual loss. She had been diagnosed with a suprasellar germinoma at 22 years of age, which...

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Bibliographic Details
Published in:European journal of ophthalmology 2008-01, Vol.18 (1), p.159-161
Main Authors: Pereira, L S, Green, A J, Hwang, T N, McCulley, T J
Format: Article
Language:English
Subjects:
Adult
alpha-Fetoproteins - analysis
Antineoplastic Combined Chemotherapy Protocols - therapeutic use
Brain Neoplasms - pathology
Brain Neoplasms - radiotherapy
Brain Neoplasms - surgery
Chorionic Gonadotropin, beta Subunit, Human - blood
Female
Germinoma - blood
Germinoma - drug therapy
Germinoma - secondary
Humans
Magnetic Resonance Imaging
Neoplasm Seeding
Optic Nerve Neoplasms - blood
Optic Nerve Neoplasms - drug therapy
Optic Nerve Neoplasms - secondary
Visual Acuity
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Summary:To report an unusual case of optic nerve seeding 12 years following treatment of a suprasellar germinoma. Observational case report. A 34-year-old woman presented with a 3-week history of subjective right eye visual loss. She had been diagnosed with a suprasellar germinoma at 22 years of age, which had been partially excised and radiated (5400 cGy). The tumor had shown complete radiographic regression without neurologic sequelae. Pertinent findings on current examination included right eye visual acuity of 20/150, right relative afferent papillary defect, and optic nerve pallor in the right eye. In addition, partial left facial paralysis was noted. Examination was otherwise unremarkable including 20/20 acuity in the left eye. Magnetic resonance imaging demonstrated abnormal enhancement and thickening of both optic nerves and along the course of the left V and VII cranial nerves. Serum levels of alpha-fetoprotein and beta-HCG were abnormal, consistent with metastatic germinoma. Following two cycles of chemotherapy (VIP-etoposide, ifosfamide, and cisplatin), visual acuity returned to 20/20 bilaterally, with corresponding radiographic improvement and normal cerebrospinal fluid cytology. Perioptic subarachnoid seeding may occur over a decade after presumed successful treatment of germinomas, suggesting the importance of lifelong observation.
ISSN:1120-6721
1724-6016
DOI:10.1177/112067210801800130