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AJNR - American Journal of Neuroradiology

Published ahead of print on July 6, 2009
doi: 10.3174/ajnr.A1696

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Susceptibility-Weighted Imaging in the Diagnosis of Early Basal Ganglia Germinoma

X. Lou^a, L. Ma^a, F.-L. Wang^b, Z.-P. Tang^c, H. Huang^a, Y.-Q. Cai^a and E.-H.-C. Wong^d

^aFrom the Departments of Radiology (X.L., L.M., H.H., Y.-Q.C.)
^bPathology (F.-L.W.), People's Liberation Army General Hospital, Beijing, China
^cDepartment of Neurology (Z.-P.T.), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
^dDepartment of Medicine and Therapeutics (E.-H.-C.W.), Chinese University of Hong Kong, Hong Kong, China.

View larger version (133K): [in this window] [in a new window]   Fig 1. MR imaging of case 1. A, Axial T2WI shows patchy hyperintensity at the left BG and the thalamus. B, T1WI shows slight hyperintensity at the left BG without obvious mass effect. C, SWI shows obvious hypointensity at the left posterior limb of internal capsule, globus pallidus, and thalamus. D, Postcontrast T1WI shows no enhancement. E and F, Repeat MR imaging 66 days later shows increased tumor size and hyperintensity on both T2WI (E) and T1WI (F), indicating intratumoral bleeding. G–I, Twenty-seven days after RT, MR images show shrinkage of the tumor on T2WI (G), T1WI (H), and postcontrast T1WI (I). Follow-up SWI was not performed in this case.

View larger version (108K): [in this window] [in a new window]   Fig 2. MR imaging of case 2. A, Axial T2WI shows patchy hyperintensity at the left BG. B, The tumor is invisible on T1WI. C, SWI shows obvious hypointensity at the globus pallidus, the genu, and the posterior limb of the internal capsule on the left side. D, Postcontrast T1WI shows no enhancement. E–H, Twenty-seven days after RT, the tumor markedly decreases on follow-up T2WI (E), T1WI (F) (still invisible), and SWI (G) but shows slight ringlike enhancement (H).

View larger version (55K): [in this window] [in a new window]   Fig 3. MR imaging of case 4. A and B, Axial T2WI (A) and T1WI (B) show heterogeneous signal-intensity changes at the right BG, involving the genu of corpus callosum and septum pellucidum, and the right thalamus is also involved (not shown). C, SWI demonstrates obvious heterogeneous hypointensity together with fluid-fluid level. D, Heterogeneous enhancement in the BG and subependymal spread are noted on the postcontrast T1WI.

View larger version (82K): [in this window] [in a new window]   Fig 4. Photomicrographs of histopathology of the right BG germinoma in case 4. A, Standard HE coloration (original magnification x 100; insert figure: original magnification x400) shows that the tumor is composed of large cells with vacuolated cytoplasm and round or ovoid nuclei with prominent nucleoli. Lymphocytic element admixes with tumor cells focally. B, Immunolabeling of germ cells with CD117a (c-kit) is positive (original magnification x400).