Synchronized multiple regression of diagnostic radiation-induced rather than spontaneous: disseminated primary intracranial germinoma in a woman: a case report

A 43-year-old Japanese woman presented to our hospital complaining of memory problems over a period of one year and blurred vision over a period of three months. Following magnetic resonance imaging (MRI), she was found to have a massive lesion in the third ventricle and small lesions in the pineal region, fourth ventricle, and in the anterior horn of the left lateral ventricle (Figure 1). A blood examination revealed hypothyroidism, and she received hormone replacement therapy with levothyroxine (50 micrograms per day for two days) until her biopsy. Before a second MRI to confirm the pathology of the lesions, she underwent a single computed tomography (CT) scan and a single cranial digital subtraction angiography (DSA). Fourteen days after the first MRI - 12 and eight days after the CT scan and DSA, respectively - a pre-operative MRI was taken, which showed a notable synchronous shrinkage of the third ventricle tumor, as well as shrinkage of the lesions in the pineal region and in the fourth ventricle. We did not administer steroids until an open biopsy pathologically diagnosed the tumor as a pure germinoma. She underwent radiation treatment to the whole brain and spine after confirmation of the pathological diagnosis (Figure 2). Although she suffered memory impairment, she went into a complete remission following the radiation therapy (Figure 3).