Blurred Vision as the Initial Presentation of Primary CNS Germinoma

Primary Central nervous system Germ cell tumors are a heterogeneous group of tumors comprising approximately 1% of primary brain tumors in pediatric and young adult patient. Bitemporal hemianopia is typically indicative of optic chiasmal involvement, most associated with compression from sellar mass, other etiologies being infiltrative or demyelinating diseases. The authors present a case of bitemporal hemianopia as the presenting symptom of Primary CNS germinoma.

Poster 44 Blurred Vision as the Initial Presentation of Primary CNS Germinoma Leroy Ekeh 1, Venkatkrish Kasetty 1, Poonam Bansal 1 1 Henry Ford Introduction: Primary Central nervous system Germ cell tumors are a heterogeneous group of tumors comprising approximately 1% of primary brain tumors in pediatric and young adult patient. Bitemporal hemianopia is typically indicative of optic chiasmal involvement, most associated with compression from sellar mass, other etiologies being infiltrative or demyelinating diseases. The authors present a case of bitemporal hemianopia as the presenting symptom of Primary CNS germinoma. Description of Cases: A 29-year-old man presented with 2 weeks of blurry vision and progressive visual field loss in both eyes. The sensory eye examination was normal except for bitemporal visual field deficit. OCT showed nasal RNFL thinning OU and GCL thinning in binasal macular hemifield respecting the vertical meridian. MRI brain revealed multiple soft enhancing masses along the pineal gland, optic chiasm, and midbrain extending into the dorsal pons, fourth ventricle and cerebral aqueduct resulting in obstructive hydrocephalus. CSF studies revealed an elevated WBC of 145, >4 oligoclonal bands with negative cytology. Differentials were demyelinating disease versus metastatic or primary tumor. CT chest, abdomen and pelvis were negative. Testicular ultrasound was negative. Patient was given a course of high dose IV steroids followed by steroid taper. NMO antibodies, MOG antibodies, paraneoplastic panel were negative. Due to worsening of lesions on follow-up MRI brain in 6 weeks, biopsy of pineal gland was done which revealed germinoma. Patient underwent external proton beam radiation at outside hospital which improved the brain lesions. Conclusions, including unique features of the case: Diagnostic dilemma can occur in cases of multiple enhancing lesions in brain – demyelinating versus metastatic /primary tumor Timely biopsy of intracranial lesion is important for the pathological diagnosis and further management. Ophthalmologic examination should be performed in patients before and after treatment to monitor for treatment response. References: None provided. Keywords: Tumors, Neuroimaging Financial Disclosures: The authors had no disclosures. Grant Support: None. Contact Information: Leroy Ekeh, [e-mail] 2023 Annual Meeting Syllabus | 109