Germinomas of the basal ganglia and thalamus: Four case reports

Figure 1 Appearance of germinomas on conventional magnetic resonance images. A-D: Case 1. A round space occupying lesion in the left basal ganglia and thalamus was hypointense on T1 and hyperintense on T2/T2-fluid-attenuated inversion recovery (FLAIR) with annular enhancement around the cystic component. Mild ipsilateral hemiatrophy appeared; E-H: Case 2. An irregular lesion in the right basal ganglia was slightly hypointense on T1 and isointense to hyperintense on T2/T2-FLAIR with mild heterogeneous enhancement and ipsilateral hemiatrophy; I-L: Case 3. An ill-defined lesion was hypointense on T1 and hyperintense on T2/T2-FLAIR in the left basal ganglia beside malacia foci. The left hemisphere showed mild atrophy. Heterogeneous enhancement was shown after gadolinium administration; M-P: Case 4. The subtle lesions were isointense on both T1 and T2/T2-FLAIR around bilateral internal capsule and thalamus. Bilateral cerebral atrophy was revealed which was predominant on the left side. No enhancement was found. T1+C: Contrast-enhanced T1-weighted imaging; FLAIR: Fluid-attenuated inversion recovery.

Figure 2 Appearance of germinomas on positron emission tomography-computed tomography. A: 18F-fluorodeoxyglucose-positron emission tomography-computed tomography (18F-FDG-PET-CT) detected diffuse low FDG uptake in the left hemisphere in case 3; B: 18F-fluorodopa-positron emission tomography-computed tomography (18F-DOPA-PET-CT) detected low uptake of DOPA in the left basal ganglia in case 3; C: 18F-FDG-PET demonstrated low uptake in the left hemisphere in case 4; D: 18F-DOPA-PET-CT showed normal metabolism in case 4. 18F-FDG-PET-CT: 18F-fluorodeoxyglucose-positron emission tomography-computed tomography; 18F-DOPA-PET-CT: 18F-fluorodopa-positron emission tomography-computed tomography.