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Nath J, Roy PS, Sarma G, Sarma B, Khanikar D. Pineal gland germinoma with spinal drop metastases: A case report and review of literature. J Cancer Res Ther 2023; 19:S904-S908. [PMID: 38384076 DOI: 10.4103/jcrt.jcrt_657_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 05/23/2022] [Indexed: 02/23/2024]
Abstract
ABSTRACT Germ cell tumor of the central nervous system (CNS) is an infrequent entity consisting of only 0.2%-1.7% of all primary CNS tumors. The pineal gland is the commonest location of CNS germinoma. Traditionally, radiotherapy alone has been used to treat localized pineal germinoma, which has delivered a very high cure rate. Spinal drop metastases from pineal germinoma can develop after a long time from diagnosis and primary treatment. Currently, craniospinal irradiation is the standard of care in metastatic pineal germinoma with spinal drop metastases along with systemic chemotherapy. Very few cases of pineal germinoma with spinal drop metastases have been published in the literature. We report a pineal gland germinoma case with spinal drop metastases in an 18-year-old boy and reviewed the published literature.
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Affiliation(s)
- Jyotiman Nath
- Department of Radiation Oncology, Dr B. Borooah Cancer Institute, Guwahati, Assam, India
| | - Partha S Roy
- Medical Oncology, Dr B. Borooah Cancer Institute, Guwahati, Assam, India
| | - Gautam Sarma
- Department of Radiation Oncology, Dr B. Borooah Cancer Institute, Guwahati, Assam, India
| | - Biswajit Sarma
- Department of Radiation Oncology, Dr B. Borooah Cancer Institute, Guwahati, Assam, India
| | - Duncan Khanikar
- Medical Oncology, Dr B. Borooah Cancer Institute, Guwahati, Assam, India
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Tsurubuchi T, Hara K, Takano S, Muroi A, Fukushima H, Mizumoto M, Sakamoto N, Matsuda M, Akutsu H, Sakurai H, Ishikawa E. Factors Influencing Craniospinal Relapse of Intracranial Germinoma After Complete Remission. World Neurosurg 2022; 166:e325-e336. [PMID: 35842173 DOI: 10.1016/j.wneu.2022.07.010] [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: 04/08/2022] [Revised: 07/02/2022] [Accepted: 07/04/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To evaluate the pathomechanism of the recurrence of intracranial germinoma after complete response and to confirm the association of the initial magnetic resonance imaging and therapeutic factors with recurrence. METHODS This study included patients who were followed up for ≥5 years and who were treated in our hospital from 1980 to 2021. Those with germinoma and germinoma with syncytiotrophoblastic giant cells were diagnosed pathologically. Data were categorizedbased on "gender," "single region," "intraventricular dissemination at the initial diagnosis," "hydrocephalus," "types of radiation therapy (RT)," and "chemotherapy." Fisher's exact probability test was used to assess differences between the no recurrence and recurrence groups. RESULTS Among 43 patients, 34 had no recurrence, 5 had delayed recurrence (≥60 months), and 4 had early recurrence (<60 months). Follow-up periods were 143.5 (60-380), 198 (88-222), and 132.5 (75-291) months for the no recurrence, delayed recurrence, and early recurrence groups, respectively. Five patients with delayed recurrence showed 3 intracranial lesions and 2 spinal lesions. Four patients with early recurrence showed 3 intracranial lesions and 1 spinal lesion. Differences in delayed recurrences (focal RT vs. RT including whole-ventricle system; P = 0.0491) were significant in Fisher's exact test. CONCLUSIONS RT including the whole-ventricle system reduces delayed craniospinal relapses including dissemination, local, and distant recurrences even ≥5 years after complete response in patients with primary central nervous system germinoma.
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Affiliation(s)
- Takao Tsurubuchi
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan.
| | - Kei Hara
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Shingo Takano
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Ai Muroi
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Hiroko Fukushima
- Department of Pediatrics, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Masashi Mizumoto
- Department of Radiation Oncology Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Noriaki Sakamoto
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan; Department of Diagnostic Pathology, University of Tsukuba, Tsukuba, Japan
| | - Masahide Matsuda
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Hiroyoshi Akutsu
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan; Department of Neurosurgery, Dokkyo Medical University, Shimotsuga, Japan
| | - Hideyuki Sakurai
- Department of Radiation Oncology Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Eiichi Ishikawa
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
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Kieu HD, Van Dang D, Le TD. Late recurrence of primary cerebellar germinoma at unusual site after complete response to radiotherapy. Surg Neurol Int 2021; 12:549. [PMID: 34877035 PMCID: PMC8645499 DOI: 10.25259/sni_663_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 10/02/2021] [Indexed: 11/22/2022] Open
Abstract
Background: The primary cerebellar germinoma is exceptional and difficult to diagnose preoperatively. Its recurrence at the middle cranial fossa after complete response to radiotherapy is unique and associated with a poor prognosis. This article aims to report the successful management of the late recurrence of primary cerebellar germinoma at an unusual site after 4 years of complete response to radiotherapy. Case Description: A 22-year-old male was admitted to our hospital with complaints of severe headache and loss of balance. Brain magnetic resonance imaging (MRI) showed a triventricular hydrocephalus due to a 45x50mm cerebellar mass. Our preliminary diagnosis was medulloblastoma. First, we placed a ventriculoperitoneal shunt with the medium-pressure valve, and then we used midline suboccipital craniotomy to remove the tumor completely. The histopathology was germinoma. The patient received 24 Gy craniospinal irradiation (CSI) with a 16 Gy boost to the primary site and had an MRI follow-up every six months. After a 4-year follow-up, he complained of recurrent severe headaches. The brain MRI illustrated a 62 × 61 mm temporal mass. We extirpated this tumor, and histopathology again revealed germinoma. After that, the patient received induction radiotherapy. The 1-year postoperative MRI showed no tumor remnant. At the time of writing, the patient had no headache and no neurological deficits. Conclusion: Regular follow-ups with routine neuroaxis MRI should be recommended to detect recurrence early for all patients with intracranial germinomas. Surgical resection, if possible, and subsequent CSI are the most effective salvage treatment for recurrent germinoma.
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Affiliation(s)
- Hung Dinh Kieu
- Department of Neurosurgery and Spine Surgery, Hanoi Medical University Hospital, Hanoi, Vietnam
| | - Duong Van Dang
- Department of Pathology, Hanoi Medical University Hospital, Hanoi, Vietnam
| | - Tam Duc Le
- Department of Neurosurgery and Spine Surgery, Hanoi Medical University Hospital, Hanoi, Vietnam
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Kutin MA, Fomichev DV, Shkarubo AN, Chernov IV, Sharipov OI, Andreev DN, Ismailov DB, Mikhailov NI, Kobyakov GL, Trunin YY, Astafyeva LI, Abdilatipov AA, Poddubsky AA, Kalinin PL. Endoscopic Transsphenoidal Approach in Treatment of Germinomas of the Chiasmosellar Region. Asian J Neurosurg 2019; 14:1190-1195. [PMID: 31903361 PMCID: PMC6896623 DOI: 10.4103/ajns.ajns_156_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Introduction Germinogenic central nervous system (CNS) tumors represent a heterogeneous group of tumors, constituting approximately 0.4% of all primary brain tumors. Removal of the tumor has no prognostic value. In "pure" primary germinomas of the CNS, the alpha-fetoprotein and human chorionic gonadotropin levels are within normal limits, and no specific biochemical tumor markers currently exist for this tumor type, making histological verification crucial for the choice of treatment tactics. When the tumor is located in the chiasmosellar region, one of the possible verification methods is endoscopic endonasal transsphenoidal biopsy. Objective The main objective of the study is to demonstrate the feasibility and safety of endoscopic transsphenoidal approach for histological verification of primary germinomas of the CNS with chiasmosellar localization. Materials and Methods The current study includes 13 patients with "pure" germinomas of the chiasmosellar region who underwent endoscopic endonasal surgical interventions with subsequent treatment according to the "Germinoma 2008" protocol. Results The extent of surgical intervention ranged from biopsy (4) to partial (5) and total (4) removal of the tumor. In all cases, histological verification of the diagnosis was achieved and none of the patients presented with cerebrospinal fluid leaks and/or meningitis in the postoperative period, allowing to evaluate endoscopic intervention in our patient series as safe and effective. Two out of 13 patients were lost to follow-up. Conclusion The endoscopic endonasal approach for histological verification and removal of chiasmosellar region germinomas is safe, and in some cases, less traumatic for the patient than transcranial and transventricular approaches.
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Affiliation(s)
- Maxim Alexandrovich Kutin
- Department of Neurooncology, N. N. Burdenko National Scientific and Practical Center for Neurosurgery, Moscow, Russia
| | | | - Alexey Nikolaevich Shkarubo
- Department of Neurooncology, N. N. Burdenko National Scientific and Practical Center for Neurosurgery, Moscow, Russia
| | - Ilia Valerievich Chernov
- Department of Neurooncology, N. N. Burdenko National Scientific and Practical Center for Neurosurgery, Moscow, Russia
| | - Oleg Ildarovich Sharipov
- Department of Neurooncology, N. N. Burdenko National Scientific and Practical Center for Neurosurgery, Moscow, Russia
| | - Dmitry Nikolaevich Andreev
- Department of Neurooncology, N. N. Burdenko National Scientific and Practical Center for Neurosurgery, Moscow, Russia
| | | | - Nikita Igorevich Mikhailov
- Department of Neurooncology, N. N. Burdenko National Scientific and Practical Center for Neurosurgery, Moscow, Russia
| | - Grigoriy Lvovich Kobyakov
- Department of Neurooncology, N. N. Burdenko National Scientific and Practical Center for Neurosurgery, Moscow, Russia
| | - Yuriy Yurievich Trunin
- Department of Radiology, N. N. Burdenko National Scientific and Practical Center for Neurosurgery, Moscow, Russia
| | - Ludmila Igorevna Astafyeva
- Department of Neurooncology, N. N. Burdenko National Scientific and Practical Center for Neurosurgery, Moscow, Russia
| | | | - Artem Andreevich Poddubsky
- Department of Neurooncology, N. N. Burdenko National Scientific and Practical Center for Neurosurgery, Moscow, Russia
| | - Pavel Lvovich Kalinin
- Department of Neurooncology, N. N. Burdenko National Scientific and Practical Center for Neurosurgery, Moscow, Russia
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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: 3] [Impact Index Per Article: 0.5] [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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The necessity of long-term follow-up including spinal examination after successful initial treatment of intracranial germinoma: case reports. Childs Nerv Syst 2016; 32:547-51. [PMID: 26351071 DOI: 10.1007/s00381-015-2872-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 08/06/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Intracranial germinomas seldom recur at spinal space following whole-brain or whole-ventricular (WV) radiotherapy. The majority of the spinal recurrence takes place within 5 years after treatment; therefore, late spinal failure beyond 5 years after successful initial treatment is rare. CASE PRESENTATIONS We describe the cases of two patients with intracranial germinoma, who developed spinal recurrence 7 and 9 years after the initial treatment with WV radiotherapy combined with and without chemotherapy, respectively. In both cases, spinal recurrent tumors were histologically diagnosed as germinoma and they were successfully treated with chemotherapy and local radiotherapy without tumor recurrence for 11 years and 11 months, respectively. CONCLUSION Intracranial germinomas may potentially present with spinal recurrence many years after successful initial WV radiotherapy. Physicians must be aware of patients' symptoms during the clinical examination. Regular long-term monitoring, including spinal examination, is necessary for 5-10 years or longer.
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Sivasubramaniam V, Zebian B, Thakur B, Saran F, Chandler C. Germinoma recurrence in the conus medullaris 12 years after remission of primary intracranial lesion in the pituitary. J Clin Neurosci 2015; 25:150-2. [PMID: 26642951 DOI: 10.1016/j.jocn.2015.06.024] [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: 05/27/2015] [Accepted: 06/01/2015] [Indexed: 10/22/2022]
Abstract
Intracranial germinomas are rare primary central nervous system tumours that are highly sensitive to radiotherapy and chemotherapy. Recurrences are infrequent, with the majority occurring within 5 years. Although multidisciplinary treatments have resulted in good event-free survival, long-term outcomes, over decades, are relatively poorly reported. We present a rare case of a recurrence in the conus medullaris 12 years after complete remission of the primary pituitary germinoma. To the best of our knowledge, this represents the first case of a significantly delayed spinal recurrence, occurring at a very distant and uncommon site, from the primary tumour. This case highlights the importance of long-term follow-up, even after complete remission, in order to identify and limit disability from late spinal recurrences in a relatively young patient population. We consider the literature regarding identifying high risk patients, and the role of craniospinal irradiation in limiting late spinal recurrences.
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Affiliation(s)
- Vinothan Sivasubramaniam
- Department of Neurosurgery, King's College Hospital, London, UK; Department of Neurosurgery, St George's Hospital, London, UK.
| | - Bassel Zebian
- Department of Neurosurgery, King's College Hospital, London, UK
| | - Bhaskar Thakur
- Department of Neurosurgery, King's College Hospital, London, UK
| | - Frank Saran
- Department of Neuro-oncology and Paediatric Oncology, The Royal Marsden NHS Foundation Trust, Surrey, UK
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Acharya S, DeWees T, Shinohara ET, Perkins SM. Long-term outcomes and late effects for childhood and young adulthood intracranial germinomas. Neuro Oncol 2014; 17:741-6. [PMID: 25422317 DOI: 10.1093/neuonc/nou311] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2014] [Accepted: 10/05/2014] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Pediatric and young adult central nervous system (CNS) germinomas have favorable cure rates. However, long-term follow-up data are limited because of the rarity of this tumor. We report the long-term overall survival (OS) and causes of late mortality for these patients. METHODS Data between 1973 and 2005 from the Surveillance, Epidemiology, and End Results (SEER) database were analyzed. Kaplan Meier survival analysis was performed on 5-year survivors of childhood CNS germinomatous germ cell tumors (GGCTs) and nongerminomatous germ cell tumors (NGGCTs). Standardized mortality ratios (SMRs) were calculated using US population data to compare observed versus expected all-cause death and death from stroke. Cumulative incidence was calculated using a competing risk model. RESULTS Four hundred five GGCTs and 94 NGGCTs cases were eligible. OS at 20 and 30 years for GGCTs was 84.1% and 61.9%, respectively, and was 86.7% for NGGCTs at both time points. Five-year survivors of GGCTs and NGGCTs experienced a 10-fold increase in mortality risk compared with their peers (SMR, 10.41; 95% confidence interval [CI], 7.71-13.76 vs SMR, 10.39;95% CI, 4.83-19.73, respectively). Five-year survivors GGCTs also experienced a nearly 59-fold increase in risk of death from stroke (SMR, 58.93; 95% CI, 18.72-142.10). At 25 years, the cumulative incidence of death due to cancer and subsequent malignancy was 16% and 6.0%, respectively. CONCLUSION Although CNS germinomas have favorable cure rates, late recurrences, subsequent malignancies, and stroke significantly affect long-term survival. Close attention to long-term follow-up with assessment of stroke risk factors is recommended.
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Affiliation(s)
- Sahaja Acharya
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri (S.A., T.D., S.M.P.); Department of Radiation Oncology, Vanderbilt University School of Medicine, Nashville, Tennessee (E.T.S.)
| | - Todd DeWees
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri (S.A., T.D., S.M.P.); Department of Radiation Oncology, Vanderbilt University School of Medicine, Nashville, Tennessee (E.T.S.)
| | - Eric T Shinohara
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri (S.A., T.D., S.M.P.); Department of Radiation Oncology, Vanderbilt University School of Medicine, Nashville, Tennessee (E.T.S.)
| | - Stephanie M Perkins
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri (S.A., T.D., S.M.P.); Department of Radiation Oncology, Vanderbilt University School of Medicine, Nashville, Tennessee (E.T.S.)
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Primary spinal germ cell tumors: a case analysis and review of treatment paradigms. Case Rep Med 2013; 2013:798358. [PMID: 24312128 PMCID: PMC3838823 DOI: 10.1155/2013/798358] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Revised: 09/02/2013] [Accepted: 09/12/2013] [Indexed: 11/26/2022] Open
Abstract
Objective. Primary intramedullary spinal germ cell tumors are exceedingly rare. As such, there are no established treatment paradigms. We describe our management for spinal germ cell tumors and a review of the literature. Clinical Presentation. We describe the case of a 45-year-old man with progressive lower extremity weakness and sensory deficits. He was found to have enhancing intramedullary mass lesions in the thoracic spinal cord, and pathology was consistent with an intramedullary germ cell tumor. A video presentation of the case and surgical approach is provided. Conclusion. As spinal cord germinomas are highly sensitive to radiation and chemotherapy, a patient can be spared radical surgery. Diverse treatment approaches exist across institutions. We advocate biopsy followed by local radiation, with or without adjuvant chemotherapy, as the optimal treatment for these tumors. Histological findings have prognostic value if syncytiotrophoblastic giant cells (STGCs) are found, which are associated with a higher rate of recurrence. The recurrence rate in STGC-positive spinal germinomas is 33% (2/6), whereas it is only 8% in STGC-negative tumors (2/24). We advocate limited volume radiotherapy combined with systemic chemotherapy in patients with high risk of recurrence. To reduce endocrine and neurocognitive side effects, cranio-spinal radiation should be used as a last resort in patients with recurrence.
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