Psychiatric manifestations as initial presentation for pediatric CNS germ cell tumors, a case series

F. Malbari, T. R. Gershon, J. H. Garvin, J. C. Allen, Y. Khakoo, Adam S. Levy, I. J. Dunkel

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Background: Central nervous system (CNS) germ cell tumors account for 3 % of all pediatric brain tumors in the USA. Presenting symptoms are typically location based with pineal tumors presenting with obstructive hydrocephalus and suprasellar tumors with hypothalamic/pituitary dysfunction and ophthalmologic abnormalities. Psychiatric manifestations such as psychosis and behavioral changes are atypical presentations of CNS germ cell tumors, with only 11 previously reported cases. Methods: This is a retrospective case series describing patients with CNS germ cell tumors with an atypical presentation including psychiatric manifestations. Information regarding clinical presentation, treatment course, and outcome were obtained. Results: We report seven patients who presented with psychiatric symptoms consisting of psychomotor delay as well as behavioral and mood changes. Six of the seven patients were diagnosed ≥6 months after onset of psychiatric symptoms. All of the seven are alive but five continue to have neurologic and psychiatric issues post treatment. Conclusions: Atypical presentations of CNS germ cell tumors can delay diagnosis and treatment and may be secondary to atypical locations as well as endocrine dysfunction manifesting as psychiatric symptoms. Delayed diagnosis did not appear to affect survival but earlier diagnosis may potentially be associated with better neurologic and psychiatric outcome. Patients who present with these symptoms and atypical neuroimaging should have a thorough evaluation for CNS germ cell tumors including serum and CSF markers. Clinicians should be aware of these less common presentations to aid in prompt diagnosis and treatment.

Original languageEnglish (US)
Pages (from-to)1359-1362
Number of pages4
JournalChild's Nervous System
Volume32
Issue number8
DOIs
StatePublished - Aug 1 2016

Fingerprint

Nervous System Neoplasms
Germ Cell and Embryonal Neoplasms
Psychiatry
Central Nervous System
Pediatrics
Nervous System
Hypothalamic Neoplasms
Pinealoma
Delayed Diagnosis
Hydrocephalus
Neuroimaging
Brain Neoplasms
Psychotic Disorders
Early Diagnosis
Therapeutics
Biomarkers
Survival

Keywords

  • CNS germ cell tumors
  • Endocrine dysfunction
  • Psychiatric

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Clinical Neurology

Cite this

Psychiatric manifestations as initial presentation for pediatric CNS germ cell tumors, a case series. / Malbari, F.; Gershon, T. R.; Garvin, J. H.; Allen, J. C.; Khakoo, Y.; Levy, Adam S.; Dunkel, I. J.

In: Child's Nervous System, Vol. 32, No. 8, 01.08.2016, p. 1359-1362.

Research output: Contribution to journalArticle

Malbari, F. ; Gershon, T. R. ; Garvin, J. H. ; Allen, J. C. ; Khakoo, Y. ; Levy, Adam S. ; Dunkel, I. J. / Psychiatric manifestations as initial presentation for pediatric CNS germ cell tumors, a case series. In: Child's Nervous System. 2016 ; Vol. 32, No. 8. pp. 1359-1362.
@article{dc210fffcca4482fa1ee75e842272c0e,
title = "Psychiatric manifestations as initial presentation for pediatric CNS germ cell tumors, a case series",
abstract = "Background: Central nervous system (CNS) germ cell tumors account for 3 {\%} of all pediatric brain tumors in the USA. Presenting symptoms are typically location based with pineal tumors presenting with obstructive hydrocephalus and suprasellar tumors with hypothalamic/pituitary dysfunction and ophthalmologic abnormalities. Psychiatric manifestations such as psychosis and behavioral changes are atypical presentations of CNS germ cell tumors, with only 11 previously reported cases. Methods: This is a retrospective case series describing patients with CNS germ cell tumors with an atypical presentation including psychiatric manifestations. Information regarding clinical presentation, treatment course, and outcome were obtained. Results: We report seven patients who presented with psychiatric symptoms consisting of psychomotor delay as well as behavioral and mood changes. Six of the seven patients were diagnosed ≥6 months after onset of psychiatric symptoms. All of the seven are alive but five continue to have neurologic and psychiatric issues post treatment. Conclusions: Atypical presentations of CNS germ cell tumors can delay diagnosis and treatment and may be secondary to atypical locations as well as endocrine dysfunction manifesting as psychiatric symptoms. Delayed diagnosis did not appear to affect survival but earlier diagnosis may potentially be associated with better neurologic and psychiatric outcome. Patients who present with these symptoms and atypical neuroimaging should have a thorough evaluation for CNS germ cell tumors including serum and CSF markers. Clinicians should be aware of these less common presentations to aid in prompt diagnosis and treatment.",
keywords = "CNS germ cell tumors, Endocrine dysfunction, Psychiatric",
author = "F. Malbari and Gershon, {T. R.} and Garvin, {J. H.} and Allen, {J. C.} and Y. Khakoo and Levy, {Adam S.} and Dunkel, {I. J.}",
year = "2016",
month = "8",
day = "1",
doi = "10.1007/s00381-016-3145-8",
language = "English (US)",
volume = "32",
pages = "1359--1362",
journal = "Child's Nervous System",
issn = "0256-7040",
publisher = "Springer Verlag",
number = "8",

}

TY - JOUR

T1 - Psychiatric manifestations as initial presentation for pediatric CNS germ cell tumors, a case series

AU - Malbari, F.

AU - Gershon, T. R.

AU - Garvin, J. H.

AU - Allen, J. C.

AU - Khakoo, Y.

AU - Levy, Adam S.

AU - Dunkel, I. J.

PY - 2016/8/1

Y1 - 2016/8/1

N2 - Background: Central nervous system (CNS) germ cell tumors account for 3 % of all pediatric brain tumors in the USA. Presenting symptoms are typically location based with pineal tumors presenting with obstructive hydrocephalus and suprasellar tumors with hypothalamic/pituitary dysfunction and ophthalmologic abnormalities. Psychiatric manifestations such as psychosis and behavioral changes are atypical presentations of CNS germ cell tumors, with only 11 previously reported cases. Methods: This is a retrospective case series describing patients with CNS germ cell tumors with an atypical presentation including psychiatric manifestations. Information regarding clinical presentation, treatment course, and outcome were obtained. Results: We report seven patients who presented with psychiatric symptoms consisting of psychomotor delay as well as behavioral and mood changes. Six of the seven patients were diagnosed ≥6 months after onset of psychiatric symptoms. All of the seven are alive but five continue to have neurologic and psychiatric issues post treatment. Conclusions: Atypical presentations of CNS germ cell tumors can delay diagnosis and treatment and may be secondary to atypical locations as well as endocrine dysfunction manifesting as psychiatric symptoms. Delayed diagnosis did not appear to affect survival but earlier diagnosis may potentially be associated with better neurologic and psychiatric outcome. Patients who present with these symptoms and atypical neuroimaging should have a thorough evaluation for CNS germ cell tumors including serum and CSF markers. Clinicians should be aware of these less common presentations to aid in prompt diagnosis and treatment.

AB - Background: Central nervous system (CNS) germ cell tumors account for 3 % of all pediatric brain tumors in the USA. Presenting symptoms are typically location based with pineal tumors presenting with obstructive hydrocephalus and suprasellar tumors with hypothalamic/pituitary dysfunction and ophthalmologic abnormalities. Psychiatric manifestations such as psychosis and behavioral changes are atypical presentations of CNS germ cell tumors, with only 11 previously reported cases. Methods: This is a retrospective case series describing patients with CNS germ cell tumors with an atypical presentation including psychiatric manifestations. Information regarding clinical presentation, treatment course, and outcome were obtained. Results: We report seven patients who presented with psychiatric symptoms consisting of psychomotor delay as well as behavioral and mood changes. Six of the seven patients were diagnosed ≥6 months after onset of psychiatric symptoms. All of the seven are alive but five continue to have neurologic and psychiatric issues post treatment. Conclusions: Atypical presentations of CNS germ cell tumors can delay diagnosis and treatment and may be secondary to atypical locations as well as endocrine dysfunction manifesting as psychiatric symptoms. Delayed diagnosis did not appear to affect survival but earlier diagnosis may potentially be associated with better neurologic and psychiatric outcome. Patients who present with these symptoms and atypical neuroimaging should have a thorough evaluation for CNS germ cell tumors including serum and CSF markers. Clinicians should be aware of these less common presentations to aid in prompt diagnosis and treatment.

KW - CNS germ cell tumors

KW - Endocrine dysfunction

KW - Psychiatric

UR - http://www.scopus.com/inward/record.url?scp=84975134238&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84975134238&partnerID=8YFLogxK

U2 - 10.1007/s00381-016-3145-8

DO - 10.1007/s00381-016-3145-8

M3 - Article

C2 - 27312077

AN - SCOPUS:84975134238

VL - 32

SP - 1359

EP - 1362

JO - Child's Nervous System

JF - Child's Nervous System

SN - 0256-7040

IS - 8

ER -