Intrasellar germinoma treated with low-dose radiation

A radiation dose lower than what had previously been recommended was given to a case of intrasellar germinoma in a 17-year-old patient who suffered from migraine-like headache for 2 years, amenorrhoea for 3 months and a body-weight loss of 10 kg over 4 months. Baseline assessment of pituitary hormone reserve was within the lower limits of the normal range, except for an elevated serum prolactin level (PRL). Magnetic resonance imaging (MRI) showed an abnormal, slightly enhanced mass in the pituitary fossa, extending along the pituitary stalk and to the hypothalamus. Transsphenoidal removal of the intrasellar part of the tumour was performed and microscopic sections of the surgical specimens revealed a pure germinoma. Adjunctive radiation therapy (RT) was given 3 weeks after surgery. A total dose of only 27 Gy was delivered to this patient. The patient’s menstrual cycles resumed in 4 months. Repeated MRI follow-up showed no recurrence of the tumour.