Bifocal intracranial tumors of nongerminomatous germ cell etiology: diagnostic and therapeutic implications
Open Access
- 2 May 2013
- journal article
- case report
- Published by Oxford University Press (OUP) in Neuro-Oncology
- Vol. 15 (7), 955-960
- https://doi.org/10.1093/neuonc/not050
Abstract
Patients presenting with synchronous bifocal intracranial tumors (masses in the pineal and neurohypophyseal region), detectable human chorionic gonadotropin (hCG) levels (5–100 mIU/mL), and normal alpha feto-protein (AFP) levels (≤10 ng/mL) are often diagnosed empirically with pure germinoma. In such scenarios, pathologic confirmation is often deferred, given that bifocal nongerminomatous germ cell tumors (NGGCTs) are considered rare and because available literature and research protocols support such an approach. We sought to characterize the association between bifocal intracranial tumors and NGGCT histology. Seventy-one patients treated for intracranial germ cell tumors at Massachusetts General Hospital in 1998–2012 were identified. Patients presenting with synchronous bifocal disease were selected for further review. Of the 71 patients presenting with intracranial germ cell tumors, 14 (19.7%) had synchronous bifocal disease. Of these 14 patients, 7 (50.0%) had germinoma, 3 (21.4%) had NGGCT, and 4 (28.6%) had hCG levels <200 mIU/mL and normal AFP levels and were treated without pathologic confirmation. Of the 3 patients with confirmed bifocal NGGCT, 2 had detectable hCG levels with AFP <10 ng/mL and 1 patient had a detectable hCG level with a modest elevation in AFP. NGGCTs should be considered in the differential diagnosis for patients presenting with bifocal intracranial tumors. Given differences in the management of germinomas and NGGCTs, clinicians should strongly consider a biopsy in patients presenting with bifocal masses and normal or modestly elevated biomarkers. Misclassification of such cases as germinomas could result in undertreatment and a possible increased risk for recurrence.This publication has 28 references indexed in Scilit:
- Frameless robotically targeted stereotactic brain biopsy: feasibility, diagnostic yield, and safetyJournal of Neurosurgery, 2012
- Neuroendoscopic biopsy of ventricular tumors: a multicentric experienceNeurosurgical Focus, 2011
- Pineal mixed germ cell tumor with a synchronous sellar lesion in the sixth decadeBrain Tumor Pathology, 2011
- Embryonal tumors with abundant neuropil and true rosettes: 2 illustrative cases and a review of the literatureNeurosurgical Focus, 2011
- Histologically confirmed intracranial germ cell tumors; an analysis of 62 patients in a single instituteVirchows Archiv A Pathological Anatomy and Histopathology, 2010
- Treatment of primary CNS germinomatous germ cell tumors with chemotherapy prior to reduced dose whole ventricular and local boost irradiationPediatric Blood & Cancer, 2010
- Pediatric Central Nervous System Germ Cell Tumors: A ReviewThe Oncologist, 2008
- Impact of Surgery, Chemotherapy and Irradiation on Long Term Outcome of Intracranial Malignant Non-Germinomatous Germ Cell Tumors: Results of the German Cooperative Trial MAKEI 89Klinische Padiatrie, 2004
- Clinical evaluation of 33 patients with histologically verified germinomaSurgical Neurology, 1994
- Pineal and CNS germ cell tumors: royal marsden hospital experience 1962–1987International Journal of Radiation Oncology*Biology*Physics, 1990