Objective: Central nervous system germ cell tumors (CNS GCT) are neoplasms typically localized in the midline structures of the brain, specifically the suprasellar/pituitary and pineal regions. Mixed GCTs have two or more histological subtypes and comprise 25% of intracranial GCTs. While many areas of neurocognitive functioning are intact in patients with GCTs, instances of memory deficits were noted despite absence of lesions involving memory structures. Limited data exist regarding unexpected memory deficits associated with GCTs. This study presents neuropsychological data of a 15-year-old male diagnosed with mixed malignant GCT. Method: The patient presented with progressively worsening headaches at age 13. Brain MRI revealed a large intraventricular tumor involving the pineal gland, septum pellucidum, left frontal horn of the lateral ventricle with parenchymal extension, and bilateral masses in the temporal horns. Treatment included chemotherapy, autologous peripheral stem cell transplantation, and craniospinal irradiation. Social and academic deficits were noted as well as depressed mood and notable weight loss secondary to poor food intake. The patient was prescribed Paxil to address symptoms of depression and an appetite stimulant. Results: Findings revealed significant impairment with both verbal and visual memory, fine motor functioning, and cognitive efficiency. Strengths were noted in verbal and visual-spatial reasoning, working memory, cognitive flexibility, and academic achievement. Conclusion: Although the current findings support previous data identifying memory deficits associated with GCTs, the impact of psychosocial components on patient presentation present challenges differentiating neurocognitive impairment from mood disturbance and cognitive changes secondary to malnourishment. Results highlight importance of considering mitigating factors in medical populations.
Neurobehavioral Findings in Pediatric Mixed Malignant Germ Cell Tumor: A Case Study
Arch Clin Neuropsychol (2015) 30 (6): 540-541.
25 August 2015
G Lam, K Kayser; B-49
Neurobehavioral Findings in Pediatric Mixed Malignant Germ Cell Tumor: A Case Study. Arch Clin Neuropsychol 2015; 30 (6): 540-541. doi: 10.1093/arclin/acv047.144
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