Primary intramedullary spinal cord germinoma: Case report and review of the literature

Primary intramedullary spinal cord germinoma is a rare neoplasm and sensitive to radiotherapy and chemotherapy. In this report, a 16-year-old girl presented with pain and numbness of both thighs, difficulty in walking, followed by urinary disturbance. Neurological examination revealed motor weakness, hypotonicity, reduced deep tendon reflexes of both lower limbs, and decrease in sensation below Th12 level. MR examination demonstrated intramedullary mass lesion of the lower thoracic spinal cord. On T2-weighted images, the lesion was heterogeneous but mostly slightly hyperintense. There were small cysts within the tumor. On T1-weighted images, the lesion was mostly hypointense. Mild and heterogeneous enhancement was observed on postcontrast T1-weighted images. No other neoplastic lesion has been found inside and outside the central nervous system. The patient underwent surgery, and the intramedullary lesion was almost totally resected. The lesion was diagnosed as germinoma histologically. Analysis of cerebrospinal fluid (CSF) obtained during operation revealed elevated level of beta-subunit of human chorionic gonadotrophin (beta-hCG). Literature review revealed that MRI findings of intramedullary spinal cord germinomas are frequently nonspecific, but these tumors sometimes have small intratumoral cysts. Germinomas should be included in the differential diagnosis, especially when an intramedullary spinal cord tumor is found in the thoracic or thoraco-lumbar region in a young adult patient. Elevated level of beta-hCG in CSF strongly suggests germinoma.