Pineal germinoma diagnosis [Neurosurgery Wiki]

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====== Pineal germinoma diagnosis ======

//J.Sales-Llopis//

//Neurosurgery Service, Alicante University General Hospital, Alicante Institute for Health and
Biomedical Research (ISABIAL - FISABIO Foundation), Alicante, Spain.//

===== Serum and cerebrospinal fluid biomarkers =====

[[Pineal germinoma serum and cerebrospinal fluid biomarkers]].

===== Histology =====
Schmalisch et al. 
((Schmalisch K, Pantazis G, Ebner FH, et al. Pineal germinoma with granulomatous reaction, often a pitfall in endoscopic biopsy. Report of two cases and review of the literature. Clin Neurol Neurosurg 2012;2013:741–5 ))
reported two cases of pineal germinoma with granulomatous reaction and found only 20 previously reported cases. These authors clearly illustrated the risk of pitfall in endoscopic biopsy: one of their patients was quite similar to Talamonti et al reported case
((Talamonti G, Ligarotti GK, Bramerio M, Imbesi F. Unusual behaviour of a pineal
germinoma mimicking neurosarcoidosis and metastasising along the endoscopic
route. BMJ Case Rep. 2013 Aug 2;2013. pii: bcr2013200278. doi:
10.1136/bcr-2013-200278. PubMed PMID: 23912659; PubMed Central PMCID: PMC3762524.
))
with the biopsy leading to the wrong diagnosis of [[neurosarcoidosis]], and germinoma becoming evident only when it progressed. Immunohistochemistry using CD117 and PLAP is usually highly sensitive for germinoma and should be considered in all granulomatous lesions of the cerebral midline
((Schmalisch K, Pantazis G, Ebner FH, et al. Pineal germinoma with granulomatous reaction, often a pitfall in endoscopic biopsy. Report of two cases and review of the literature. Clin Neurol Neurosurg 2012;2013:741–5))
((Nakamura H, Takeshima H, Makino K, et al. C-kit expression in germinoma: an immunohistochemistry-based study. J Neurooncol 2005;2013:163–7)).

===== CT =====

[[Germinoma]]s typically demonstrate increased attenuation relative to [[gray matter]] on [[CT]] as well as a draped configuration with respect to the posterior third ventricle 
((Dumrongpisutikul N, Intrapiromkul J, Yousem DM. Distinguishing between germinomas and pineal cell tumors on MR imaging. AJNR Am J Neuroradiol. 2012;33(3):550–555.))
((Smith AB, Rushing EJ, Smirniotopoulos JG. From the archives of the AFIP: lesions of the pineal region: radiologic-pathologic correlation. Radiographics. 2010;30(7):2001–2020)).

===== MRI =====

[[Pineal germinoma magnetic resonance imaging]].


===== References =====