Brain Tumor Res Treat.  2013 Apr;1(1):50-53. 10.14791/btrt.2013.1.1.50.

A Suprasellar Cystic Germ Cell Tumor Initially Diagnosed as an Arachnoid Cyst

• Choi HS
• Han JH
• Bang JS
• Kim IA
• Kim CY

• KMID: 2165224
• DOI: http://doi.org/10.14791/btrt.2013.1.1.50

Abstract

We report here the case of a suprasellar cystic germ cell tumor (GCT) initially diagnosed as an arachnoid cyst. A 10-year-old boy experienced headache, dizziness, and diplopia, and was shown to have an approximately 2 cm suprasellar cyst. Two months after endoscopic third ventriculostomy was performed, a 5-6 cm cystic mass with an internal enhancing component was observed in the suprasellar cistern. Serum human chorionic gonadotropin levels were slightly increased in the serum and cerebrospinal fluid (55 and 162 IU/L, respectively) but were strikingly elevated in the cystic fluid (14,040 IU/L). The patient showed complete remission, with only a very small cystic lesion remaining after surgery, chemotherapy, and radiation treatment for a suprasellar mixed GCT. However, follow-up after treatment was complicated by moyamoya syndrome and cerebral infarction. GCT can be considered as a rare differential diagnosis in the case of a suprasellar cystic mass. Evaluation of tumor markers and close follow-up will be necessary.

Keyword

Suprasellar germ cell tumor; Arachnoid cyst; Moyamoya syndrome

MeSH Terms

Arachnoid*
Central Nervous System Cysts*
Cerebral Infarction
Cerebrospinal Fluid
Child
Chorionic Gonadotropin
Diagnosis, Differential
Diplopia
Dizziness
Drug Therapy
Follow-Up Studies
Germ Cells*
Headache
Humans
Male
Moyamoya Disease
Neoplasms, Germ Cell and Embryonal*
Biomarkers, Tumor
Ventriculostomy
Chorionic Gonadotropin
Tumor Markers, Biological

Figure

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  Fig. 1 A: Brain magnetic resonance imaging at initial presentation with a 2 cm suprasellar cystic lesion. B and C: An increased a 5-6 cm large cystic mass with internal enhancing component in the suprasellar cistern 2 months later (arrows). D: A small residual cyst after completion of chemotherapy and radiation treatment.

• 

  Fig. 2 Brain MRA on ischemic symptoms 9 months after completion of treatment. Bilateral T carotid (ICA bifurcation) occlusion with left MCA occlusion and focal stenosis at the right P1, compatible with moyamoya syndrome (A and B). TFCA: severe stenosis both in distal ICAs, MCAs and ACAs with leptomeningeal and transdural collateral flow (C and D). MRA: magnetic resonance angiography, ICA: internal carotid artery, MCA: middle cerebral artery, TFCA: transfemoral carotid angiography, ACA: anterior carotid artery.

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