Intracranial Germ Cell Tumors: Spectrum of Disease in an Indian Cohort and Management Strategies

Abstract

Background:Germ cell tumors (GCTs) represent approximately 3% of primary pediatric brain tumors in the West, whereas in Asia, they constitute between 8% and 15% of pediatric brain tumors.Methods:We retrospectively studied all patients with intracranial GCT managed at our institute from January 1998 to December 2013. The clinical data and radiological data were analyzed.Results:Forty-eight patients with intracranial GCT including 36 males and 16 females formed the cohort. The proportion of GCT in our study was 0.29%. The mean age was 16.5 ± 2.5 years. Germinomas constituted 56.3% and nongerminomatous GCTs constituted 43.7% of all the tumors. The most common location was posterior third ventricle (58.3%) followed by suprasellar (22.9%). Histopathological diagnosis was obtained in almost all patients (96%). Surgical procedures included tumor decompression (71.7%), stereotactic biopsy (13%), and endoscopic third ventriculostomy and biopsy (15%). Patient's age, location of the tumor, and histology did not influence the survival. Women with GCTs had poorer survival when compared to men.Conclusions:The present study documented a lower hospital-based incidence of GCT in Indian cohort. A multidisciplinary approach including surgical strategy based on location, appropriate radiation planning, and chemotherapy is needed for effective treatment and improved outcomes.

Neurological and endocrinological manifestations of 49 children with intracranial pure germinoma at initial diagnosis in Taiwan

“…These manifestations have also been reported with other intracranial tumors. 22d24 The rate of visual disturbance in this study was lower than that of a study of Indian adults with intracranial GCTs, 3 but similar to that of another study of children. 14 Children may be unable to express such symptoms to their caregivers, and approaching young children regarding this problem may be difficult.…”

“…CNS GCTs account for approximately 3% of primary pediatric brain tumors in the West, 1.1% of primary intracranial malignant tumors in Turkey, 2 and 8%e15% of pediatric brain tumors in Asia (based on data from Taiwan, Japan, and South Korea). 3 The incidence in the United States is 0.10 per 100,000 person-years. 4 According to the database on childhood brain tumors (age 18 years) by the Childhood Cancer Foundation in Taiwan, from 1995 to 2018 a total of 2878 CNS neoplasm cases occurred, which accounted for 19.8% of all pediatric neoplasms.…”

“…6 Germinoma accounts for more than half of CNS GCTs in childhood. 3,7,8 Patients with pure germinoma have a survival proportion of >90%. 9 Clinical manifestations depend on the size and site of tumors.…”

Basal Ganglia Germinoma in an Adolescent: A Case Report

“…6 As GCTs, especially germinomas, are relatively radiochemo sensitive and potentially curable, early diagnosis is helpful for better outcome. 2 4…”

“…2,4 In early stages, patients with GCT arising from these locations are frequently present with vague symptoms such as poor school performance or mild speech disturbance. 2,[4][5][6] Neuroimaging findings in initial stages are often subtle. 6 As GCTs, especially germinomas, are relatively radiochemo sensitive and potentially curable, early diagnosis is helpful for better outcome.…”