Surgical management of primary central nervous system germ cell tumors

Souweidane, Mark M.; Krieger, Mark D.; Weiner, Howard L.; Finlay, Jonathan L.

doi:10.3171/2010.5.peds09112

Cited by 67 publications

(33 citation statements)

References 51 publications

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“…The accurate diagnosis of GCTs remains a difficult task because of the presence of heterogeneous subtypes and the possibility of misdiagnosis by stereotactic or endoscopic biopsy. 21 Therefore, we performed a comprehensive review of surgical methods, histological diagnoses, and tumor markers to make the most plausible clinical diagnosis in each case. A clinical diagnosis based on these data may be the most reliable diagnosis for intracranial GCTs, because an initial radical resection is not routinely applied to intracranial GCTs.…”

Section: Discussionmentioning

confidence: 99%

The enigma of bifocal germ cell tumors in the suprasellar and pineal regions: synchronous lesions or metastasis?

Phi¹,

Kim²,

Lee³

et al. 2013

PED

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Object Intracranial germ cell tumors (GCTs) frequently present with bifocal lesions in both the suprasellar and pineal areas. The pathogenesis of these bifocal GCTs has been the subject of controversy. Bifocal GCTs may be caused by synchronous tumors or by metastatic spread of tumor cells from one site to the other. The prognosis associated with bifocal GCTs has also been a cause of concern. Methods The authors constructed a single-institution patient cohort comprising 181 patients with intracranial GCTs. The clinical characteristics of bifocal GCTs were compared with those of suprasellar and pineal GCTs. Results Bifocal GCTs were observed in 23 patients (12.8%). Eighteen patients presented with bifocal GCTs that were diagnosed as germinomas, but 5 patients exhibited mixed GCTs. Analyses of age distributions and comparisons of tumor sizes were compatible with a model of a metastatic origin of bifocal GCTs. Eleven patients (47.8%) presenting with bifocal GCTs exhibited tumor seeding at presentation. Tumor seeding was significantly associated with bifocal lesions (p < 0.001). Patients with bifocal germinomas showed significantly shorter event-free survival and overall survival than did those presenting with germinomas from a single site of origin. Conclusions Bifocal GCTs are not restricted to germinomas, as had been previously reported, but do include mixed GCTs. The authors hypothesize that bifocal GCTs may result from the metastatic spread of suprasellar or pineal GCTs. The bifocal presentation of germinomas may be a poor prognostic sign and should alert clinicians to the possibility of a disseminated disease.

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Section: Discussionmentioning

confidence: 99%

The enigma of bifocal germ cell tumors in the suprasellar and pineal regions: synchronous lesions or metastasis?

Phi¹,

Kim²,

Lee³

et al. 2013

PED

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“…In the paper by Souweidane et al, 2 the authors offer their synthesis of the Proceedings from the Second International Symposium on Central Nervous System Germ Cell Tumors. Given that the literature on the treatment of germ cell tumors (GCTs) has evolved over the past 2 decades, the authors are able to make a number of contemporary points that help clarify the current approach to this challenging group of tumors.…”

Section: Semmes-murphey Clinic Memphis Tennesseementioning

confidence: 99%

Editorial

Boop¹

2010

PED

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“…Patient prognosis directly depends on the histologic diagnosis as either pure germinoma or NGGCT [11]. Pure germinomas (negative AFP, β-HCG < 50) [7, 9, 12] have an excellent response to chemotherapy and radiation with a 5-year survival around 90%, whereas patients with NGGCTs (AFP > 0 mIU/mL and β-HCG > 50 mIU/mL) experience lower responsiveness and higher rates of recurrence.…”

Section: Discussionmentioning

confidence: 99%

“…NGGCTs are more resistant to therapy, with a 5-year overall survival rate of 30–50% [2, 7-9]. In all cases, recurrent disease, as defined by new disease on imaging and/or persistently elevated tumor markers, is treated by intensified therapy, and oftentimes includes consideration of second-look surgery [9]. …”

Section: Introductionmentioning

confidence: 99%

Imaging Features Predictive of Recurrence in Pediatric Intracranial Germ-Cell Tumors

et al. 2019

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Background/Aims: Intracranial germ-cell tumors (GCTs) are a heterogeneous group of tumors that vary in their response to treatment. Standard treatment consists of chemotherapy and radiation therapy, with the consideration of second-look surgery in resistant disease. The present study aims to inform therapy by characterizing features on pretreatment imaging associated with recurrence. Methods: Children with intracranial GCTs treated at a single institution between January 2000 and October 2016 were retrospectively reviewed under an Institutional Review Board-approved protocol. Imaging variables identified on pretreatment imaging were calciﬁcations, cysts, heterogeneity of enhancement, blood products, hydrocephalus, gradient echo susceptibility, restricted diffusion, invasiveness, and extent of edema. Tumor recurrence was used as the primary outcome variable. Results and Conclusion: Fifty-two patients (39 males, mean age at diagnosis: 13 ± 5 years, 34 germinoma, 18 nongerminomatous GCT [NGGCT]) were reviewed. Thirty-three percent of the patients reviewed had recurrence (7 germinoma, 11 NGGCT). Recurrence was associated with invasiveness as seen on preoperative imaging (p = 0.0385) and cystic tumor (p = 0.048).

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Surgical management of primary central nervous system germ cell tumors

Cited by 67 publications

References 51 publications

The enigma of bifocal germ cell tumors in the suprasellar and pineal regions: synchronous lesions or metastasis?

The enigma of bifocal germ cell tumors in the suprasellar and pineal regions: synchronous lesions or metastasis?

Editorial

Imaging Features Predictive of Recurrence in Pediatric Intracranial Germ-Cell Tumors

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