Germinoma physical examination

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Simrat Sarai, M.D. [2]

Overview

Physical Examination

The clinical evaluation for germ cell tumors should include the following:

  • General physical examination
  • Check of growth parameters
  • Careful neurological evaluation
  • Assessment of primary and secondary sexual characteristics
  • Ophthalmological exam.

Radiographic characteristics of CNS germ cell tumors GCTs cannot reliably differentiate germinomas from nongerminomatous germ cell tumors NGGCTs. The diagnosis of GCTs is based on the following:

  • Clinical signs and symptoms
  • Tumor markers (Alpha-fetoprotein (AFP) and beta subunit human chorionic gonadotropin (beta-HCG) in both serum and CSF, lumbar CSF cytology)
  • Neuroimaging
  • Cytological cerebrospinal fluid (CSF) and histological confirmation
  • Magnetic resonance imaging (MRI) of brain and spine with gadolinium.
  • Evaluation of pituitary/hypothalamic function.
  • Visual-field examinations for suprasellar or hypothalamic tumors.
  • A baseline neuropsychological examination when symptoms of endocrine deficiency and raised intracranial pressure are resolved.

HEENT

  • Paralysis of upward gaze
  • Pupils nonreactive to light perception and accommodation or pupils which react better to accommodation than light
  • Nystagmus
  • Failure of convergence
  • Lid retraction
  • Visual-field examinations
  • Papilledema
  • A baseline neuropsychological examination is also performed

Neuromuscular

  • Patient is usually oriented to persons, place, and time: However, altered mental status may be present if there is increased intracranial pressure
  • Clonus may be present
  • Hyperreflexia / hyporeflexia / areflexia
  • Positive Babinski / plantar reflex unilaterally/bilaterally
  • Proximal/distal muscle weakness unilaterally/bilaterally
  • Paralysis of upward gaze, failure of convergence, and pupils nonreactive to light perception and accommodation suggestive of cranial nerve II and III
  • Unilateral/bilateral upper/lower extremity weakness
  • Unilateral/bilateral sensory loss in the upper/lower extremity
  • Ataxia
  • Normal finger-to-nose test / Dysmetria
  • Dysdiadochokinesia

References


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