OBJECTIVE AND IMPORTANCE: We report an extremely rare case of primary intramedullary germinoma in the cervical spinal cord arising in an 18-year-old man who had not undergone previous surgery or irradiation. CLINICAL PRESENTATION: The patient had a 2-month history of intermittent neck pain and a 4-week history of bilateral hand paresthesias and weakness. A magnetic resonance imaging scan demonstrated a heterogeneous cervical spine lesion with marked contrast enhancement extending from C3 to C6. INTERVENTION: The patient underwent a cervical laminotomy with tumor resection, and pathological examination revealed the tumor to be a germinoma. He recovered well from the surgery with minimal neurological deficits. A postoperative magnetic resonance imaging scan of the brain and spinal cord did not show any other tumors. In addition, imaging studies of the mediastinum, testes, and the rest of the body also did not demonstrate any other tumors. The patient received local radiation as well as three courses of chemotherapy. CONCLUSION: To our knowledge, this is the first report of an intramedullary cervical spine germinoma with confirmed tissue diagnosis. Although extremely uncommon, the possibility of germinoma should be included in the differential diagnosis for primary intramedullary spinal cord tumors.
OBJECTIVE AND IMPORTANCE: We report an extremely rare case of primary intramedullary germinoma in the cervical spinal cord arising in an 18-year-old man who had not undergone previous surgery or irradiation. CLINICAL PRESENTATION: The patient had a 2-month history of intermittent neck pain and a 4-week history of bilateral hand paresthesias and weakness. A magnetic resonance imaging scan demonstrated a heterogeneous cervical spine lesion with marked contrast enhancement extending from C3 to C6. INTERVENTION: The patient underwent a cervical laminotomy with tumor resection, and pathological examination revealed the tumor to be a germinoma. He recovered well from the surgery with minimal neurological deficits. A postoperative magnetic resonance imaging scan of the brain and spinal cord did not show any other tumors. In addition, imaging studies of the mediastinum, testes, and the rest of the body also did not demonstrate any other tumors. The patient received local radiation as well as three courses of chemotherapy. CONCLUSION: To our knowledge, this is the first report of an intramedullary cervical spine germinoma with confirmed tissue diagnosis. Although extremely uncommon, the possibility of germinoma should be included in the differential diagnosis for primary intramedullary spinal cord tumors.
Authors: Charles Long; Thomas A Novack; Stuart Changoor; Kumar Sinha; Ki Soo Hwang; Michael J Faloon; Arash Emami Journal: J Am Acad Orthop Surg Glob Res Rev Date: 2020-07