Authors: Hena Parvin , Anwesha Dutta , Subhrajit Hazra

Abstract

Background: Intracranial germ cell tumors (iGCTs) are a rare and heterogeneous group of neoplasms originating from germ cells within the central nervous system (CNS). These tumors are a subclass of CNS germ cell tumors (GCTs) that are typically observed in 1st to 2nd decades of life. They tend to occur in the midline, either at the pineal region or along the floor of the third ventricle/suprasellar region. Less commonly, both regions can be involved, presenting as bifocal tumors which usually carry a worse prognosis. Such bifocal lesions can be either two independent primary germinomas (GEs) (known as true bifocal GE) or it can be one primary GE with metastases (known as false bifocal GE). Bifocal presentation is mostly seen in GE, but some of the patients may have mixed GCT. Clinical features are mainly due to the mass effect and involvement of sellar and supra-sellar regions.
Case Presentation: A 21-year-old male presented with complaints of erectile dysfunction, lack of libido, headache, polydipsia,
polyuria, diplopia, and recent onset blurring of vision over the past 6 months to 1 year. Radiological investigations revealed
the presence of true bifocal iGCTs, which were confirmed to be β-human chorionic gonadotropin producing GEs upon
histopathological and immunohistochemical analysis. The patient showed complete resolution of the tumor following treatment.
Conclusion: Intracranial GEs are highly radiosensitive tumors often characterized by insidious symptoms, leading to a significant delay in diagnosis, with patients often seeking medical assistance only when their daily activities are severely impaired. However, this delay could be mitigated by obtaining a thorough patient history and maintaining a high index of suspicion for intracranial GEs, particularly in the appropriate age groups. Our case report emphasizes the importance of a multidisciplinary team approach in facilitating timely and informed decision-making for optimal patient management.

Keywords: Germ cell tumor, intracranial GCT, intracranial germinoma, bifocal germinoma.