• Zhengxiang Luo, Zhongrun Qian, Kun Yang, Hongyi Liu, Wenbin Zhang, and Yanjun Zeng.
• Department of Neurosurgery, NanJing Brain Hospital affiliated with NanJing Medical University, NanJing, China.
• World Neurosurg. 2017 Feb 1; 98: 871.e1-871.e7.

BackgroundPrimary intracranial germinomas occurring in the cerebral hemisphere are extremely rare, with only a few reported cases in the literature. We describe an unusual case of a primary germinoma that developed in the insular lobe, with little involvement in the basal frontal lobe.Case DescriptionA 19-year-old man presented with headache and vomiting. Magnetic resonance imaging showed a solitary, ring-like enhanced lesion in the left hemisphere, and a preliminary diagnosis of glioma was made. Surgery was performed, and the diagnosis of germinoma was made based on the histopathologic results.ConclusionsThe causes of ectopic germinomas of the midline structures of the brain are still unclear, but the theory of misplacement may partially clarify this phenomenon. Reflecting a lack of definitive management guidelines for atypical germinoma, the present patient was treated with focal radiotherapy around the lesion after surgery and achieved remission by 34 months postoperatively.Copyright © 2016 Elsevier Inc. All rights reserved.

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