Central nervous system tumors

The clinical manifestations of patients with intracranial germ cell tumor are closely related to the age of patients, the location and size of tumors, and whether they are accompanied by implantation metastasis:

1. Suprasellar region

NGGCT is rare, mostly GE. It is reported that women under 10 years old are more common, and men over 20 years old are more common, and there is no gender difference between 10 and 20 years old. The main manifestations are: ① different degrees of diabetes insipidus, and all are the first symptoms: 24-hour urine volume 3000 ~ 7200ml, urine specific gravity 1.008 ~ 1.010. ② Visual impairment, visual field. ③ Endocrine disorders, anterior pituitary dysfunction, growth hormone deficiency, growth and development obviously lag behind children of the same age, sexual development disorders or degeneration, rare precocious puberty. ④ The symptoms of increased intracranial pressure are not obvious or delayed.

2. Basal ganglia

In rare NGGCT, GE in this area is almost all male, and most of the symptoms are progressive hemilimb weakness, which can begin in the upper or lower limbs. The tumor progression is relatively slow, usually more than 1 year. The symptoms of intracranial hypertension such as headache and vomiting appeared in the late stage of the disease.

3. Pineal area

It was the best site of NGGCT, and the incidence was significantly higher than suprasellar region. Germ cell tumors in this area are more common in men. For example, male children with chorionic epithelial carcinoma and germinoma may develop precocious puberty because the syncytiotrophoblast cells in the tumor are able to secrete β-HCG into the cerebrospinal fluid and produce lutein-like hormones. Due to the proximity to the midbrain aqueduct, the pressure leads to obstructive hydrocephalus, and the GCT in this area causes the symptoms of increased intracranial pressure earlier. Almost all patients present with typical signs and symptoms of hydrocephalus: headache, vomiting, drowsiness, memory impairment, and abnormal enlargement of head circumference and seizures in infants. Parinaud syndrome may occur in some patients: paralysis of the upward movement of both eyes, but it is not accompanied by paralysis of the converging movement of the eyes. Patients with larger tumors may also have signs of cerebellar compression such as tinnitus, hearing impairment, gait instability, ataxia, and eye-level tremor. There were some disturbance of consciousness due to tumor apoplexy.

Implantation metastasis: If the shed tumor cells spread along the cerebrospinal fluid, it can involve nerve roots or the spinal cord, causing corresponding clinical symptoms and signs.