Three patients, ages 9, 12, and 13 years (1 boy and 2 girls), diagnosed with intracranial germinoma are reported from University Children’s Hospital Homburg, Germany. Presenting symptoms and signs prompting an MRI were nausea, vomiting, strabismus, and intermittent headache for 1 year in case 1, migraine in case 2, and a 3-year history of growth retardation in case 3. Patients 1 and 2 also had a history of growth retardation for 2 years. MRI showed tumors in the pituitary region in cases 1 and 2, and a thickened pituitary stalk in case 3. Clinical and laboratory findings showed panhypopituitarism, subclinical diabetes insipidus and hypothyroidism, and growth hormone deficiency in cases 1, 2, and 3, respectively. CSF levels of Beta-human chorionic gonadotropins (B-hCG) were not elevated, and diagnosis of germinoma was confirmed by biopsy. Treatment by chemotherapy and/or irradiation was successful. At follow-up of 12 to 18 months, patients were in remission. Patients 1 and 2 were dependent on thyroxin, hydrocortisone, and growth hormone, while patient 3 needed no further hormone substitution. [1]

COMMENT. The incidence of pediatric intracranial germ cell tumors varies worldwide, the average being 3.6%, and higher in Asia than the Western hemisphere. Germinomas arise in the pineal or suprasellar regions and if diagnosed early, have a good prognosis. The present small series demonstrates the value of secondary growth retardation as an early sign of suprasellar germinoma. Diagnosis is made by MRI, and a CSF B-hCG level above 50 U/l (under 7 U/I is normal). Biopsy may be necessary when the hormone levels are not elevated.

A larger series of 26 children with germ cell tumors (17 germinomas and 9 teratomas), not cited above, was reported from the University Hospital Hamburg (Ped Neur Briefs May 1996) [2]. Tumor location was the pineal region in 69% and suprasellar/hypothalamic in 31%. Presenting symptoms were increased intracranial pressure, Parinaud’s syndrome, and endocrine deficits. Long-term survival rate was 88% for germinomas and 43% for malignant teratomas.