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Washington University Experience | NEOPLASMS (NON-GLIAL NON-NEURONAL) | Germ Cell Neoplasm - Germinoma | 1A0 Case 1 History
Case 1 History ---- The patient was a 17 year old male with cognitive impairment diagnosed as fronto-temporal dementia with intellectual disability, autism and a history of a cerebrovascular accident. His history is significant for gross and fine motor delay since birth and a cerebrovascular accident in July 2007 at age 14 characterized by sudden onset of right hemiparesis and aphasia. Imaging showed the development of a lesion in the left deep lenticular region and adjacent corona radiata. An extensive workup at SLCH at that time included angiography that showed narrowing of multiple vessels including large middle and distal cervical carotid arteries and the distal vertebral arteries, findings thought consistent with fibromuscular dysplasia. Subsequently, his cognitive status and facility with expressive language decreased rapidly. Later MRI examination showed left hemispheric abnormalities involving the basal ganglia and genu of the corpus callosum. An MRA revealed normal flow in the vessels of the circle of Willis. In December 2010, he presented with increasing confusion, right homonomous hemianopsia, right upper motor neuron facial weakness and dense right hemiplegia. MRI in January 2010 showed a small circumscribed area of hyperintense diffusion restriction in the left basal ganglia. The patient developed seizures in March 2010. The last hospital admission of this patient was in September 2010 for placement of a gastrostomy tube. During that hospital stay the patient developed acute renal insufficiency and multiorgan failure secondary to Pseudomonas urosepsis. After antibiotic treatment, his condition stabilized and he was discharged to hospice care and died. ---- At autopsy, the diagnosis of germinoma, disseminated, involving predominantly perivascular left>right cerebral hemispheres, basal ganglia, thalamus, brainstem and pineal gland
