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Cocito C, Martin B, Giantini-Larsen AM, Valcarce-Aspegren M, Souweidane MM, Szalontay L, Dahmane N, Greenfield JP. Leptomeningeal dissemination in pediatric brain tumors. Neoplasia 2023; 39:100898. [PMID: 37011459 PMCID: PMC10124141 DOI: 10.1016/j.neo.2023.100898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 03/09/2023] [Accepted: 03/13/2023] [Indexed: 04/03/2023]
Abstract
Leptomeningeal disease (LMD) in pediatric brain tumors (PBTs) is a poorly understood and categorized phenomenon. LMD incidence rates, as well as diagnosis, treatment, and screening practices, vary greatly depending on the primary tumor pathology. While LMD is encountered most frequently in medulloblastoma, reports of LMD have been described across a wide variety of PBT pathologies. LMD may be diagnosed simultaneously with the primary tumor, at time of recurrence, or as primary LMD without a primary intraparenchymal lesion. Dissemination and seeding of the cerebrospinal fluid (CSF) involves a modified invasion-metastasis cascade and is often the result of direct deposition of tumor cells into the CSF. Cells develop select environmental advantages to survive the harsh, nutrient poor and turbulent environment of the CSF and leptomeninges. Improved understanding of the molecular mechanisms that underlie LMD, along with improved diagnostic and treatment approaches, will help the prognosis of children affected by primary brain tumors.
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Cohen D, Litofsky NS. Diagnosis and Management of Pineal Germinoma: From Eye to Brain. Eye Brain 2023; 15:45-61. [PMID: 37077304 PMCID: PMC10108908 DOI: 10.2147/eb.s389631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 04/03/2023] [Indexed: 04/21/2023] Open
Abstract
Pineal germinomas can be very complex in terms of presentation, diagnosis, and management. This review attempts to simplify this complexity in an organized manner, addressing the anatomic relationships that provide the basis for the uniqueness of pineal germinoma. Ocular findings and signs and symptoms of elevated intracranial pressure are the keys to suspecting the diagnosis and obtaining the necessary imaging and cerebrospinal fluid studies. Other symptoms can suggest spread beyond the pineal region. Surgery may only be needed to obtain tissue for a definitive diagnosis, as germinoma is highly responsive to chemotherapy and focused radiation therapy. Hydrocephalus, usually related to tumor obstruction of the cerebral aqueduct, may also need to be addressed. Outcome for pineal germinoma is usually excellent, but relapse can occur and may require additional intervention. These issues are detailed in this review.
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Affiliation(s)
- David Cohen
- Department of Neurology, University of Missouri School of Medicine, Columbia, MO, USA
| | - N Scott Litofsky
- Department of Neurosurgery, University of Missouri School of Medicine, Columbia, MO, USA
- Correspondence: N Scott Litofsky, Department of Neurosurgery, One Hospital Drive, MC, 321, Columbia, MO, 65212, USA, Tel +1-573-882-4908, Fax +1-573-884-5184, Email
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3
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Morana G, Shaw D, MacDonald SM, Alapetite C, Ajithkumar T, Bhatia A, Brisse H, Jaimes C, Czech T, Dhall G, Fangusaro J, Faure-Conter C, Fouladi M, Hargrave D, Harreld JH, Mitra D, Nicholson JC, Souweidane M, Timmermann B, Calaminus G, Bartels U, Bison B, Murray MJ. Imaging response assessment for CNS germ cell tumours: consensus recommendations from the European Society for Paediatric Oncology Brain Tumour Group and North American Children's Oncology Group. Lancet Oncol 2022; 23:e218-e228. [PMID: 35489353 DOI: 10.1016/s1470-2045(22)00063-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 01/16/2022] [Accepted: 01/18/2022] [Indexed: 11/27/2022]
Abstract
Homogeneous and common objective disease assessments and standardised response criteria are important for better international clinical trials for CNS germ cell tumours. Currently, European protocols differ from those of North America (the USA and Canada) in terms of criteria to assess radiological disease response. An international working group of the European Society for Paediatric Oncology Brain Tumour Group and North American Children's Oncology Group was therefore established to review existing literature and current practices, identify major challenges regarding imaging assessment, and develop consensus recommendations for imaging response assessment for patients with CNS germ cell tumours. New clinical imaging standards were defined for the most common sites of CNS germ cell tumour and for the definition of locoregional extension. These new standards will allow the evaluation of response to therapy in patients with CNS germ cell tumours to be more consistent, and facilitate direct comparison of treatment outcomes across international studies.
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Affiliation(s)
- Giovanni Morana
- Department of Neurosciences, Neuroradiology Unit, University of Turin, Turin, Italy
| | - Dennis Shaw
- Department of Radiology, Seattle Children's Hospital and University of Washington, Seattle, WA, USA
| | - Shannon M MacDonald
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Claire Alapetite
- Department of Radiation Oncology and Proton Center, Institut Curie, Paris, France
| | - Thankamma Ajithkumar
- Department of Radiation Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Aashim Bhatia
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Hervé Brisse
- Department of Imaging, Institut Curie, Paris, France
| | - Camilo Jaimes
- Department of Radiology, Boston Children's Hospital and Dana-Farber/Harvard Cancer Center, Boston, MA, USA
| | - Thomas Czech
- Department of Neurosurgery, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
| | - Girish Dhall
- Division of Pediatric Hematology and Oncology, Department of Pediatrics School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jason Fangusaro
- Aflac Cancer and Blood Disorders Center, Emory University and Children's Healthcare of Atlanta, Atlanta, GA, USA
| | | | - Maryam Fouladi
- Department of Pediatric Hematology and Oncology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Darren Hargrave
- Department of Paediatric Haematology and Oncology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Julie H Harreld
- Department of Radiology, Dartmouth-Hitchcock Medical Center, Norris Cotton Cancer Center, Lebanon, NH, USA
| | - Dipayan Mitra
- Department of Neuroradiology, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - James C Nicholson
- Department of Paediatric Haematology and Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Mark Souweidane
- Department of Neurosurgery, NewYork-Presbyterian Weill Cornell Medical Center, New York, NY, USA
| | - Beate Timmermann
- Department of Particle Therapy, University Hospital, Essen, Germany; West German Proton Therapy Centre, Essen, Germany; West German Cancer Center, Essen, Germany
| | - Gabriele Calaminus
- Department of Paediatric Haematology and Oncology, University Hospital Bonn, Bonn, Germany
| | - Ute Bartels
- Pediatric Brain Tumour Program, Hospital for Sick Children, Toronto, ON, Canada
| | - Brigitte Bison
- Department of Neuroradiology, University Hospital Augsburg, Augsburg, Germany
| | - Matthew J Murray
- Department of Paediatric Haematology and Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK; Department of Pathology, University of Cambridge, Cambridge, UK.
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4
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Frappaz D, Dhall G, Murray MJ, Goldman S, Faure Conter C, Allen J, Kortmann R, Haas-Kogen D, Morana G, Finlay J, Nicholson JC, Bartels U, Souweidane M, Schöenberger S, Vasiljevic A, Robertson P, Albanese A, Alapetite C, Czech T, Lau CC, Wen P, Schiff D, Shaw D, Calaminus G, Bouffet E. Intracranial germ cell tumors in Adolescents and Young Adults: European and North American consensus review, current management and future development. Neuro Oncol 2021; 24:516-527. [PMID: 34724065 PMCID: PMC8972311 DOI: 10.1093/neuonc/noab252] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The incidence of intracranial germ cell tumors (iGCT) is much lower in European and North American (E&NA) than in Asian population. However, E&NA cooperative groups have simultaneously developed with success treatment strategies with specific attention paid to long-term sequelae. Neurological sequelae may be reduced by establishing a diagnosis with an endoscopic biopsy and/or cerebrospinal fluid (CSF) and/or serum analysis, deferring the need to perform a radical surgery. Depending on markers and/or histological characteristics, patients are treated as either germinoma or non-germinomatous germ cell tumors (NGGCT). Metastatic disease is defined by a positive CSF cytology and/or distant drops in craniospinal MRI. The combination of surgery and/or chemotherapy and radiation therapy is tailored according to grouping and staging. With more than 90% 5-year event-free survival (EFS), localized germinomas can be managed without aggressive surgery, and benefit from chemotherapy followed by whole ventricular irradiation with local boost. Bifocal germinomas are treated as non-metastatic entities. Metastatic germinomas may be cured with craniospinal irradiation. With a 5-year EFS over 70%, NGGCT benefit from chemotherapy followed by delayed surgery in case of residual disease, and some form of radiotherapy. Future strategies will aim at decreasing long-term side effects while preserving high cure rates.
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Affiliation(s)
- D Frappaz
- Institut d'Hématologie Oncologie Pédiatrique, Lyon, France
| | - G Dhall
- University of Alabama at Birmingham (UAB), Birmingham, USA
| | - M J Murray
- Department of Pathology, University of Cambridge, Cambridge, UK.,Department of Paediatric Haematology and Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - S Goldman
- Phoenix Children's Hospital University of Arizona, USA
| | - C Faure Conter
- Institut d'Hématologie Oncologie Pédiatrique, Lyon, France
| | - J Allen
- NYU Grossman School, New York, USA
| | - R Kortmann
- University of Leipzig Medical Center; Leipzig, Germany
| | | | | | - J Finlay
- Nationwide Children's Hospital, Colombus, USA
| | - J C Nicholson
- Department of Paediatric Haematology and Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Ute Bartels
- The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - M Souweidane
- Memorial Sloan Kettering Cancer Center, New York, USA
| | - S Schöenberger
- Department of Pediatric Hematology and Oncology, University Hospital Essen, Essen, Germany
| | - A Vasiljevic
- Centre de Pathologie et Neuropathologie Est, Hospices Civils de Lyon, France
| | | | | | | | - T Czech
- Medical University of Vienna, Austria
| | - C C Lau
- Connecticut Children's Medical Center, USA
| | - P Wen
- University of Leipzig Medical Center; Leipzig, Germany
| | - D Schiff
- University of Virginia School of Medicine, Charlottesville, USA
| | - D Shaw
- Seattle Children's Hospital and University of Washington, Seattle USA
| | | | - E Bouffet
- The Hospital for Sick Children, University of Toronto, Toronto, Canada
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5
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Kanamori M, Takami H, Suzuki T, Tominaga T, Kurihara J, Tanaka S, Hatazaki S, Nagane M, Matsuda M, Yoshino A, Natsumeda M, Yamaoka M, Kagawa N, Akiyama Y, Fukai J, Negoto T, Shibahara I, Tanaka K, Inoue A, Mase M, Tomita T, Kuga D, Kijima N, Fukami T, Nakahara Y, Natsume A, Yoshimoto K, Keino D, Tokuyama T, Asano K, Ujifuku K, Abe H, Nakada M, Matsuda KI, Arakawa Y, Ikeda N, Narita Y, Shinojima N, Kambe A, Nonaka M, Izumoto S, Kawanishi Y, Kanaya K, Nomura S, Nakajima K, Yamamoto S, Terashima K, Ichimura K, Nishikawa R. Necessity for craniospinal irradiation of germinoma with positive cytology without spinal lesion on MR imaging-A controversy. Neurooncol Adv 2021; 3:vdab086. [PMID: 34355172 PMCID: PMC8331051 DOI: 10.1093/noajnl/vdab086] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background Cerebrospinal fluid (CSF) cytology and spinal MR imaging are routinely performed for staging before treatment of intracranial germinoma. However, the interpretation of the results of CSF cytology poses 2 unresolved clinical questions: (1) Does positive CSF cytology correlate with the presence of spinal lesion before treatment? and (2) Is craniospinal irradiation (CSI) necessary for patients with positive CSF cytology in the absence of spinal lesion? Methods Multicenter retrospective analyses were performed based on a questionnaire on clinical features, spinal MR imaging finding, results of CSF cytology, treatments, and outcomes which was sent to 86 neurosurgical and 35 pediatrics departments in Japan. Pretreatment frequencies of spinal lesion on MR imaging were compared between the patients with positive and negative cytology. Progression-free survival (PFS) rates were compared between patients with positive CSF cytology without spinal lesion on MR imaging treated with CSI and with whole brain or whole ventricular irradiation (non-CSI). Results A total of 92 germinoma patients from 45 institutes were evaluated by both CSF cytology and spinal MR images, but 26 patients were excluded because of tumor markers, the timing of CSF sampling or incomplete estimation of spinal lesion. Of the remaining 66 germinoma patients, spinal lesions were equally identified in patients with negative CSF cytology and positive cytology (4.9% and 8.0%, respectively). Eleven patients treated with non-CSI had excellent PFS comparable to 11 patients treated with CSI. Conclusion CSI is unnecessary for germinoma patients with positive CSF cytology without spinal lesions on MR imaging.
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Affiliation(s)
- Masayuki Kanamori
- Department of Neurosurgery, Tohoku University Graduate School Medicine, Sendai, Miyagi, Japan
| | - Hirokazu Takami
- Department of Neurosurgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Division of Brain Tumor Translational Research, National Cancer Center Research Institute, Tokyo, Japan
| | - Tomonari Suzuki
- Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Teiji Tominaga
- Department of Neurosurgery, Tohoku University Graduate School Medicine, Sendai, Miyagi, Japan
| | - Jun Kurihara
- Department of Neurosurgery, Saitama Children's Medical Center, Saitama, Saitama, Japan
| | - Shota Tanaka
- Department of Neurosurgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Seiji Hatazaki
- Department of Neurosurgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Motoo Nagane
- Department of Neurosurgery, Kyorin University Faculty of Medicine, Mitaka, Tokyo, Japan
| | - Masahide Matsuda
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Atsuo Yoshino
- Department of Neurological Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Manabu Natsumeda
- Department of Neurosurgery, Brain Research Institute, Niigata University, Niigata, Niigata, Japan
| | - Masayoshi Yamaoka
- Department of Pediatrics, The Jikei University School of Medicine, Tokyo, Japan
| | - Naoki Kagawa
- Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Yukinori Akiyama
- Department of Neurosurgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Junya Fukai
- Department of Neurological Surgery, Wakayama Medical University School of Medicine, Wakayama, Wakayama, Japan
| | - Tetsuya Negoto
- Department of Neurosurgery, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Ichiyo Shibahara
- Department of Neurosurgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Kazuhiro Tanaka
- Department of Neurosurgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Akihiro Inoue
- Department of Neurosurgery, Ehime University Graduate School of Medicine, Touon, Ehime, Japan
| | - Mitsuhiro Mase
- Department of Neurosurgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
| | - Takahiro Tomita
- Department of neurosurgery, University of Toyama, Toyama, Toyama, Japan
| | - Daisuke Kuga
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Fukuoka, Japan
| | - Noriyuki Kijima
- Department of Neurosurgery, National Hospital Organization Osaka National Hospital, Osaka, Osaka, Japan
| | - Tadateru Fukami
- Department of Neurosurgery, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Yukiko Nakahara
- Department of Neurosurgery, Faculty of Medicine, Saga University, Saga, Saga, Japan
| | - Atsushi Natsume
- Department of Neurosurgery, Nagoya University School of Medicine, Nagoya, Aichi, Japan
| | - Koji Yoshimoto
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Kagoshima, Japan
| | - Dai Keino
- Division of Hematology/Oncology, Kanagawa Children`s Medical Center, Yokohama, Kanagawa, Japan
| | - Tsutomu Tokuyama
- Department of Neurosurgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Kenichiro Asano
- Department of Neurosurgery, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
| | - Kenta Ujifuku
- Department of Neurosurgery, Nagasaki University School of Medicine, Nagasaki, Nagasaki, Japan
| | - Hiroshi Abe
- Department of Neurosurgery, Fukuoka University Faculty of Medicine, Fukuoka, Fukuoka, Japan
| | - Mitsutoshi Nakada
- Department of Neurosurgery, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Ishikawa, Japan
| | - Ken-Ichiro Matsuda
- Department of Neurosurgery, Yamagata University Faculty of Medicine, Yamagata, Yamagata, Japan
| | - Yoshiki Arakawa
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Kyoto, Japan
| | - Naokado Ikeda
- Department of Neurosurgery and Neuroendovascular Surgery, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Yoshitaka Narita
- Departments of Neurosurgery and Neuro-Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Naoki Shinojima
- Department of Neurosurgery, Kumamoto University Hospital, Kumamoto, Kumamoto, Japan
| | - Atsushi Kambe
- Division of Neurosurgery, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Yonago, Tottori, Japan
| | - Masahiko Nonaka
- Department of Neurosurgery, Kansai Medical University, Hirakata, Osaka, Japan
| | - Shuichi Izumoto
- Department of Neurosurgery, Kindai University Faculty of Medicine, Higashi-Osaka, Osaka, Japan
| | - Yu Kawanishi
- Department of Neurosurgery, Kochi Medical School, Kochi University, Nankoku, Kochi, Japan
| | - Kohei Kanaya
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Sadahiro Nomura
- Department of Neurosurgery, Yamaguchi University School of Medicine, Ube, Yamaguchi, Japan
| | - Kohei Nakajima
- Department of Neurosurgery, Tokushima University School of Medicine, Tokushima, Tokushima, Japan
| | - Shohei Yamamoto
- Department of Pediatrics, Showa University Fujigaoka Hospital, Yokohama, Kanagawa, Japan
| | - Keita Terashima
- Division of Neuro-Oncology, Children's Cancer Center, National Center for Child Health and Development, Tokyo, Japan
| | - Koichi Ichimura
- Division of Brain Tumor Translational Research, National Cancer Center Research Institute, Tokyo, Japan
| | - Ryo Nishikawa
- Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
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Sbardella E, Puliani G, Feola T, Pofi R, Pirchio R, Sesti F, Verdecchia F, Gianfrilli D, Moffat D, Isidori AM, Grossman AB. A clinical approach to parasellar lesions in the transition age. J Neuroendocrinol 2021; 33:e12995. [PMID: 34138496 DOI: 10.1111/jne.12995] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 03/23/2021] [Accepted: 05/11/2021] [Indexed: 12/16/2022]
Abstract
Many reviews have summarised the pathology and management of the parasellar region in adult patients, although an analysis of these aspects in the transition years, from puberty onset to the age of peak bone mass, has been lacking. A comprehensive search of English-language original articles, published from 2000 to 2020, was conducted in the MEDLINE database (December 2019 to March 2020). We selected all studies regarding epidemiology, diagnosis and management of the following parasellar lesions: germinoma, craniopharyngioma, Langerhans cell histiocytosis, optic glioma, hypothalamic hamartoma, tuber cinereum hamartoma, cranial chordoma, Rathke cleft cyst, hypophysitis and hypothalamitis during the transition age from childhood to adulthood. In the present review, we provide an overview of the principal parasellar lesions occurring in the transition age. Symptoms are usually a result of the mass effect of the lesions on nearby structures, as well as anterior pituitary deficits. Diabetes insipidus occurs frequently in these patients. In this age group, pubertal developmental disorders may be more evident compared to other stages of life. Parasellar lesions in the transition age mostly include neoplastic lesions such as germinomas, hamartomas, optic gliomas, craniopharyngiomas Langerhans cell histiocytosis and chordomas, and rarely inflammatory lesions (hypophysitis, hypothalamitis). There are limited data on the management of parasellar lesions in the transition age. Endocrine evaluation is crucial for identifying conditions that require hormonal treatment so that they can be treated early to improve the quality of life of the individual patient in this complex age range. The clinical approach to parasellar lesions involves a multidisciplinary effort.
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Affiliation(s)
- Emilia Sbardella
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Giulia Puliani
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
- Oncological Endocrinology Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Tiziana Feola
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
- Neuroendocrinology, Neuromed Institute, IRCCS, Pozzilli, Italy
| | - Riccardo Pofi
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Rosa Pirchio
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, Naples, Italy
| | - Franz Sesti
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Federica Verdecchia
- Dipartimento Pediatrico Universitario Ospedaliero, Bambino Gesù Children Hospital, Rome, Italy
| | - Daniele Gianfrilli
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Daniel Moffat
- Department of Neurosurgery, Barts and the London NHS Trust, London, UK
| | - Andrea M Isidori
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Ashley B Grossman
- Department of Endocrinology, Oxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, University of Oxford, Oxford, UK
- Centre for Endocrinology, Barts and the London School of Medicine, London, UK
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Jacques A, Thomas L, Fenouil T, Fomekong F, Ameli R, Ducray F. Primary intracranial germinoma mimicking meningioma in an elderly patient. Rev Neurol (Paris) 2021; 177:1020-1022. [PMID: 33795143 DOI: 10.1016/j.neurol.2020.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 11/24/2020] [Accepted: 11/26/2020] [Indexed: 11/30/2022]
Affiliation(s)
- A Jacques
- Department of Neuro-Oncology, Hôpital Pierre Wertheimer, Bron, France
| | - L Thomas
- Department of Neuro-Oncology, Hôpital Pierre Wertheimer, Bron, France
| | - T Fenouil
- Department of Neuropathology, Hôpital Pierre Wertheimer, Bron, France
| | - F Fomekong
- Department of Skull Base and Pituitary Surgery, Hôpital Pierre Wertheimer, Bron, France
| | - R Ameli
- Department of Neuroradiology, Hôpital Pierre Wertheimer, Bron, France
| | - F Ducray
- Department of Neuro-Oncology, Hôpital Pierre Wertheimer, Bron, France; Inserm U1052, Université Lyon 1, Lyon, France.
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8
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Takami H, Perry A, Graffeo CS, Giannini C, Narita Y, Nakazato Y, Saito N, Nishikawa R, Matsutani M, Ichimura K, Daniels DJ. Comparison on epidemiology, tumor location, histology, and prognosis of intracranial germ cell tumors between Mayo Clinic and Japanese consortium cohorts. J Neurosurg 2020; 134:446-456. [PMID: 32005022 DOI: 10.3171/2019.11.jns191576] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 11/27/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Central nervous system (CNS) germ cell tumors (GCTs) are rare malignant neoplasms that arise predominantly in adolescents and young adults. CNS GCTs demonstrate characteristic trends in national associations, with implications for both tumor incidence and genetics. Although the incidence of CNS GCTs is markedly higher in East Asia than Western countries, direct comparative analyses between these CNS GCT populations are limited. METHODS In Japan, to facilitate the genomic analyses of CNS GCTs, the Intracranial Germ Cell Tumor Genome Analysis Consortium was established in 2011, and more than 200 cases of GCTs are available for both tumor tissue and clinical data, which is organized by the National Cancer Center (NCC) Japan. At the Mayo Clinic, there have been 98 cases of intracranial GCTs treated by the Department of Neurologic Surgery since 1988. In this paper, the authors compared the epidemiology, clinical presentation including location and histology, and prognosis between cases treated in the US and Japan. RESULTS There was no significant difference in age and sex distributions between the databases. However, there was a significant difference in the tumor locations; specifically, the frequency of basal ganglia was higher in the NCC database compared with the Mayo Clinic (8.4% vs 0%, p = 0.008), and bifocal location (neurohypophysis and pineal gland) was higher at the Mayo Clinic than at the NCC (18.8% vs 5.8%, p = 0.002). There was no difference in histological subdivisions between the databases. There was no difference in progression-free survival (PFS) and overall survival (OS) of germinoma cases and OS of nongerminomatous GCT (NGGCT) cases treated with chemotherapy and radiation therapy covering whole ventricles. However, PFS of NGGCTs differed significantly, and was better in the NCC cohorts (p = 0.04). CONCLUSIONS There appears to be a differential distribution of GCTs by neuroanatomical location between major geographic and national groups. Further study is warranted to better characterize any underlying genomic, epigenetic, or environmental factors that may be driving the phenotypic differences.
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Affiliation(s)
- Hirokazu Takami
- Departments of1Neurologic Surgery and
- 3Division of Brain Tumor Translational Research, National Cancer Center, Tokyo, Japan
- 4Department of Neurosurgery, Faculty of Medicine, University of Tokyo, Japan
| | | | | | - Caterina Giannini
- 2Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Yoshitaka Narita
- 5Department of Neurosurgery and Neuro-oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Yoichi Nakazato
- 6Department of Pathology, Hidaka Hospital, Gunma, Japan; and
| | - Nobuhito Saito
- 4Department of Neurosurgery, Faculty of Medicine, University of Tokyo, Japan
| | - Ryo Nishikawa
- 7Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, Saitama, Japan
| | - Masao Matsutani
- 7Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, Saitama, Japan
| | - Koichi Ichimura
- 3Division of Brain Tumor Translational Research, National Cancer Center, Tokyo, Japan
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Sakakura K, Tsurubuchi T, Masumoto T, Muroi A, Ishikawa E, Matsumura A. Primary cavernous sinus germinoma with atypical extension pattern: a case report and review of the literature. Childs Nerv Syst 2019; 35:1615-1619. [PMID: 30796559 DOI: 10.1007/s00381-019-04092-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 02/14/2019] [Indexed: 11/26/2022]
Abstract
Primary intracranial germinoma is a rare central nervous system tumor that usually arises in the pineal and the supra-sellar region. Here, we report a rare case of primary intracavernous sinus germinoma with an atypical extension pattern, with a comparison to germinomas originating from the cavernous sinus as described in the existing literature. A 12-year-old boy was admitted to our hospital with the chief complaint of the left-side ptosis and double vision. Magnetic resonance imaging showed homogenous enhanced mass lesion in the pineal region together with mass lesions in the lateral ventricle, left cavernous sinus, and temporal lobe, extending into the left masticator space. The enhanced mass in the intracavernous sinus originated from the cavernous sinus. Endoscopic third ventriculostomy and tumor biopsy was done. Pathological diagnosis was pure germinoma. After six courses of chemotherapy followed by radiation therapy, all the lesions decreased in size significantly. Only faint enhancement around the masticator space remained. We report a rare case of a germinoma that developed mainly in the cavernous sinus with additional tumor masses in the pineal region, ventricles, and temporal lobe. Although the lesions shrank significantly on the post-chemoradiation imaging, a long follow-up is necessary not only to check for symptoms, but also monitor imaging findings for possible serial changes in the residual region of the masticator space.
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Affiliation(s)
- Kazuki Sakakura
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan.
| | - Takao Tsurubuchi
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Tomohiko Masumoto
- Department of Radiology, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Ai Muroi
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Eiichi Ishikawa
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Akira Matsumura
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
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Abu Arja MH, Stalling M, Governale LS, Pierson CR, Rusin JA, Palmer JD, Finlay JL, Olshefski R, Boué DR. Germinoma Involving the Retina: An Unusual Presentation of Recurrent Intracranial Mixed Germ Cell Tumor. World Neurosurg 2019; 124:116-120. [PMID: 30630044 DOI: 10.1016/j.wneu.2018.12.143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 12/23/2018] [Accepted: 12/26/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND We report a patient with primary central nervous system mixed malignant germ cell tumor (GCT) who presented with recurrent malignant germinomatous infiltration of the retina. CASE DESCRIPTION A ten-year-old girl initially presented with a large suprasellar mixed malignant GCT with a near-complete response after initial induction chemotherapy and irradiation. Three and half years after initial therapy, she presented with progressively worsening vision in her left eye. Magnetic resonance imaging showed infiltrative changes within the left optic nerve but no discrete mass. Serum and cerebrospinal fluid (CSF) tumor markers were not elevated and CSF cytology was negative. Left optic nerve biopsy confirmed the presence of mature teratoma and pure germinoma components. She was treated with gross-total resection of the left eye and optic nerve and chemotherapy. Histopathologic evaluation of the optic nerve showed only mature teratoma elements but with pure germinoma cells infiltrating the inner layers of the retina. CONCLUSIONS Loco-regional extension of suprasellar GCT to the optic nerve is not uncommon; however, infiltration of the tumor into the retina is not reported in the literature. Early detection of optic pathway involvement and proper delineation of the irradiation field may prevent GCT infiltration of the retina with subsequent vision loss.
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Affiliation(s)
- Mohammad H Abu Arja
- The Division of Hematology, Oncology and Blood and Marrow Transplant, Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH 43205 USA.
| | - Melissa Stalling
- The Department of Pathology & Laboratory Medicine, Nationwide Children's Hospital, Columbus, OH 43205 and The Department of Pathology, The Ohio State University, College of Medicine, Columbus, OH 43210 USA
| | - Lance S Governale
- Department of Neurosurgery, University of Florida, Gainesville, FL 32611 USA
| | - Christopher R Pierson
- The Department of Pathology & Laboratory Medicine, Nationwide Children's Hospital, Columbus, OH 43205 and The Department of Pathology, The Ohio State University, College of Medicine, Columbus, OH 43210 USA; The Department of Biomedical Education and Anatomy, The Ohio State University, College of Medicine, Columbus, OH 43210 USA
| | - Jerome A Rusin
- The Department of Radiology, Nationwide Children's Hospital, Columbus, OH, 43205 USA
| | - Joshua D Palmer
- The Department of Radiation Oncology, The James Cancer Hospital at The Ohio State University, Columbus, OH, 43210 USA
| | - Jonathan L Finlay
- The Division of Hematology, Oncology and Blood and Marrow Transplant, Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH 43205 USA
| | - Randal Olshefski
- The Division of Hematology, Oncology and Blood and Marrow Transplant, Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH 43205 USA
| | - Daniel R Boué
- The Department of Pathology & Laboratory Medicine, Nationwide Children's Hospital, Columbus, OH 43205 and The Department of Pathology, The Ohio State University, College of Medicine, Columbus, OH 43210 USA
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Chen R, Tao C, You C, Ju Y. Fast-developing fatal diffuse leptomeningeal dissemination of a pineal germinoma in a young child: a case report and literature review. Br J Neurosurg 2018; 36:262-269. [PMID: 30451003 DOI: 10.1080/02688697.2018.1520804] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Intracranial germinomas are uncommon and constitute less than 1% of all intracranial tumors. They usually arise in the midline of the brain, most commonly in the pineal region. Pineal germinomas tend to spread through the cerebrospinal fluid (CSF). However, pineal germinomas with fast-developing diffuse subarachnoid/leptomeningeal dissemination are extremely rare, especially in young children. METHODS The case of a 4-year-old boy with a pineal germinoma who died of diffuse subarachnoid/leptomeningeal dissemination 1 month after radiotherapy is reported. A PubMed search with specific key terms was used to review cases of pineal germinomas with metastasis. RESULTS The patient presented with a two-week history of worsening headache, visual disturbances and nonprojectile vomiting. Parinaud's sign was positive on physical examination. Head computed tomography (CT)/magnetic resonance imaging (MRI) revealed a lesion in the pineal region with eccentric calcification and obvious supratentorial hydrocephalus. Pineal germinoma was suspected. A ventriculoperitoneal (VP) shunt followed by focal radiotherapy ameliorated the headaches and visual disturbances. The patient was discharged home without further treatment due to financial difficulties. One month after discharge, he was readmitted due to worsening headache, vomiting and lethargy. MRI showed a decrease in the size of the pineal lesion but revealed a diffuse leptomeningeal enhancement including the sulcus, basal cistern, prepontine cistern, and supravermian cistern. The patient's condition deteriorated rapidly, and he died 26 hours after readmission. The characteristics of pineal germinomas with metastasis are reported based on a review of the literature. CONCLUSIONS Metastases in pineal germinomas predominately occur in adolescents or young adults, most commonly as spinal "drop metastases." Dissemination usually develops several years after the initial tumor diagnosis and has a relatively good clinical prognosis. However, fast widespread subarachnoid/leptomeningeal dissemination and sudden death may occur in a young child before salvage treatment, as in the presented case.
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Affiliation(s)
- Ruiqi Chen
- a Department of Neurosurgery , West China Hospital, Sichuan University , Chengdu , Sichuan 610041 , China
| | - Chuanyuan Tao
- a Department of Neurosurgery , West China Hospital, Sichuan University , Chengdu , Sichuan 610041 , China
| | - Chao You
- a Department of Neurosurgery , West China Hospital, Sichuan University , Chengdu , Sichuan 610041 , China
| | - Yan Ju
- a Department of Neurosurgery , West China Hospital, Sichuan University , Chengdu , Sichuan 610041 , China
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