Occurrence of basal ganglia germ cell tumors without a mass.

OBJECTIVE To report a case series in which basal ganglia calcifications without mass effect proved to be germ cell tumors. DESIGN Case series. SETTING Tertiary care hospital. PATIENTS Four patients. INTERVENTIONS Computed tomography, magnetic resonance imaging, positron emission tomography, biopsy, chemotherapy, and radiation therapy. MAIN OUTCOME MEASURES Recognition of clinical syndrome and radiological features. RESULTS All patients had progressive hemiparesis, and 1 patient also had frontal lobe dementia. Imaging demonstrated progressive asymmetric signal abnormality with basal ganglia calcification and associated brainstem atrophy. Fludeoxyglucose F 18-positron emission tomography showed hypometabolism in contrast to malignant glioma. CONCLUSION Germ cell tumor should be considered in patients with an indolently progressive neurological course, particularly if basal ganglia calcification is present with or without enhancement, asymmetric brain atrophy, or a mass.