青少年基底节区生殖细胞瘤早期诊断的探讨

The early diagnosis of juvenile germinoma originating from the basal ganglia and thalamus

目的探讨青少年发病的基底节区生殖细胞瘤早期诊断。方法收集2000年以来首都医科大学宣武医院收治的青少年基底节区生殖细胞瘤患者，对其临床资料以及影像学等辅助检查进行回顾性分析。结果共收集8例基底节区生殖细胞瘤患者，平均年龄16．1岁（10～20岁）。临床症状与体征多表现为一侧肢体偏瘫，伴失语和智能障碍。头颅CT表现为基底节区病灶呈高密度或钙化，头颅MRI表现为长T1、T2异常信号，常伴有病灶侧脑萎缩，病灶囊性变和（或）出血。2例头颅磁共振波谱（MRS）表现为病灶部位N-乙酰天门冬氨酸降低，胆碱峰增高。2例腰穿检查示脑脊液人绒毛膜促性腺激素（HCG）升高。结论青少年男性根据临床症状体征，头颅CT、MRI和MRS检查，结合血和脑脊液HCG升高等综合多种临床资料可早期诊断基底节区生殖细胞瘤。

Objective To explore the early diagnosis of germinoma originating from the basal ganglia （BG） and thalamus during juveniles. Methods Retrospective analysis was clone with the clinical cases of germinomas in BG and thalamus from 2000 to 2009. The symptoms, signs, neuroimaging, cerebrospinal fluid （CSF） findings were analyzed and related literature were reviewed. Results Eight patents were collected. The main symptoms were hemiplegia, associated with aphasia and/or impaired cognition. Brain CT showed high density and calcification. Abnormal TI and T2 signal were found in brain MRI frequently associated with ipsilateral hemisphere atrophy. MRS showed increased choline and decreased N-acetylaspartate level. Elevated CSF human chorionie gonadotrophin level were found in two of them. Conclusions Germinoma in BG and thalamus predominates in a boy. The neuroimaging features are very informative for early diagnosis.