Bifocal germinomas in the pineal region and hypothalamo-neurohypophyseal axis: Primary or metastasis?

•We investigated whether bifocal germinomas (BFGs) in the pineal region and hypothalamo-neurohypophyseal axis (HNA) are primary germinomas of dual origin.•We analyzed the clinical and MRI features of 95 neurohypophyseal germinomas cases.•Primary and metastatic HNA germinomas have distinct features.•These features differentiated 21 cases of true versus false BFGs.•The differential diagnosis of true versus false BFGs may guide radiotherapy strategy.