scholarly journals A Rare Case of Intracranial Nongerminomatous Germ Cell Tumor in a 21-Year-Old Romanian Male

2020 ◽  
Vol 2020 ◽  
pp. 1-5 ◽  
Author(s):  
Minesh Nandi ◽  
Rahul Anil ◽  
Edward Hamaty ◽  
William Adams ◽  
David Stidd ◽  
...  
Keyword(s):  
Germ Cell ◽  
Tumor Markers ◽  
Germ Cell Tumor ◽  
Rare Case ◽  
Obstructive Hydrocephalus ◽  
Elevated Serum ◽  
Germ Cell Tumors ◽  
Cell Tumor ◽  
Third Ventriculostomy ◽  
Intracranial Germ Cell Tumors

Extragonadal germ cell tumors are a rare entity that is more prevalent in infants and young children, with preference to midline structures. The category of intracranial germ cell tumors is divided into pure germ cell tumors (GCTs) versus nongerminomatous germ cell tumors (NGGCTs). They are usually present in the second decade of life with a male preponderance. We present here a rare case of intracranial NGGCT in a 21-year-old Romanian male, who presented with complaints of emesis, ataxic gait, and diplopia. A computed tomography scan of the head in the emergency department revealed a pineal/suprapineal mass along with obstructive hydrocephalus and dilated lateral and third ventricles without any bleeding. MRI of the cervical, thoracic, and lumbar spine showed no evidence of leptomeningeal metastasis. The patient had elevated serum markers of beta-hCG and AFP, which pointed towards a diagnosis of nongerm cell tumor, as in pure GCTs, these markers are normal. To relieve the obstruction from the mass effect, the patient had an endoscopic third ventriculostomy (EVT). However, after the procedure, he developed central diabetes insipidus as a complication with a triphasic response. Biopsy of the mass revealed atypical cells with granular architecture and atypical glands with positive immune histological markers for NGGCT. These findings supported the diagnosis of mixed germ cell tumor with yolk sac carcinoma and seminoma components. Patient’s transient central diabetes resolved with normalization in his urine output. He was eventually stabilized and returned to Romania for further management. In summary, intracranial germ cell tumors are rare brain tumors that should be distinguished based on histology and tumor markers as they will help in the guidance of therapy. An initial evaluation with neuroimaging, tumor markers, cytology from CSF, and biopsy is a must to distinguish further treatment and prognosis.

scholarly journals GCT-06. DIAGNOSIS OF A RARE CASE OF RECURRENT GERM CELL TUMOR BY CSF PLACENTAL ALKALINE PHOSPHATASE PRESENTING WITH DIFFUSE INTRAAXIAL ABNORMALITY IN THE LOWER BRAINSTEM

2020 ◽  
Vol 22 (Supplement_3) ◽  
pp. iii329-iii329
Author(s):  
Hiroki Yamada ◽  
Tomohiro Abiko ◽  
Hirokazu Fujiwara ◽  
Kazunari Yoshida ◽  
Hikaru Sasaki
Keyword(s):  
Alkaline Phosphatase ◽  
Germ Cell ◽  
Germ Cell Tumor ◽  
Rare Case ◽  
Cervical Spinal Cord ◽  
Germ Cell Tumors ◽  
Cell Tumor ◽  
Placental Alkaline Phosphatase ◽  
Steroid Pulse ◽  
Platinum Based Chemotherapy

Abstract INTRODUCTION Germ cell tumors in the central nervous system (CNS) typically arise either at suprasellar and/or pineal region, and occasionally at basal ganglia. We report a case of diagnostically challenging, recurrent germ cell tumor presented with diffuse intraaxial abnormality in and across the lower brainstem, which was diagnosed by the elevated placental alkaline phosphatase (PLAP) level in cerebrospinal fluid (CSF). CASE DESCRIPTION: A 28-year-old man had been treated by chemoradiotherapy at the previous hospital for bifocal suprasellar and pineal lesions with the provisional diagnosis of germinoma without histological confirmation. Three years later, he presented with progressive weakness of bilateral extremities for weeks. Magnetic resonance imaging showed a diffuse, bilaterally symmetric high intensity lesion on T2-weighted image with slight contrast enhancement across the ventral side of the medulla oblongata to the upper cervical spinal cord. Serum and CSF hCG, hCG-β, and AFP were all negative. Since the image findings were atypical for recurrent germ cell tumor, some kind of myelitis was initially suspected. Therefore, steroid pulse therapy was administered. However, the patient’s symptom was still gradually progressing. Then, the CSF PLAP turned out to be positive, indicating the recurrence of germinoma. Accordingly, platinum-based chemotherapy was administered, and the imaging findings, patient’s symptoms, and CSF PLAP began to improve. The patient is to be treated with radiotherapy following chemotherapy. CONCLUSION We report a rare case of CNS germ cell tumor that presented with diffuse intraaxial lesion in the lower brainstem in which examination of CSF PLAP was extremely useful.

Primary chemotherapy for intracranial germ cell tumors: Results of the third international CNS germ cell tumor study

2010 ◽  
Vol 54 (3) ◽  
pp. 377-383 ◽  
Author(s):  
Nasjla Saba da Silva ◽  
Andrea M. Cappellano ◽  
Blanca Diez ◽  
Sergio Cavalheiro ◽  
Sharon Gardner ◽  
...  
Keyword(s):  
Germ Cell ◽  
Germ Cell Tumor ◽  
Germ Cell Tumors ◽  
Cell Tumor ◽  
Primary Chemotherapy ◽  
The Third ◽  
Tumor Study ◽  
Intracranial Germ Cell Tumors ◽  
Cns Germ Cell Tumor

A retrospective analysis of patients with poor-risk germ cell tumor (PRGCT) treated at Indiana University from 2000 to 2010.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 4557-4557
Author(s):  
Nabil Adra ◽  
Costantine Albany ◽  
Daniel Sonnenburg ◽  
Yan Tong ◽  
Nasser H. Hanna ◽  
...  
Keyword(s):  
Germ Cell ◽  
Retrospective Analysis ◽  
Tumor Markers ◽  
Germ Cell Tumor ◽  
Germ Cell Tumors ◽  
Continuous Variable ◽  
Cell Tumor ◽  
P Value ◽  
Indiana University ◽  
Poor Risk

4557 Background: PRGCT represents 14% of germ cell tumors, with 2-year PFS of 50%. PRGCT is defined by primary mediastinal non-seminomatous germ cell tumor (PMNSGCT), non-pulmonary visceral metastasis (NPVM), AFP > 10,000 or hCG > 50,000. This analysis attempts to identify subsets of patients with more or less favorable outcomes among the poor risk groups. Methods: Retrospective analysis of all patients with testicular cancer seen at Indiana University (IU) from 2000-2010. 291 patients with PRGCT identified of whom 79 received initial therapy at IU. We analyzed the following variables: primary site testis/retroperitoneal (T/RP) vs. PMNSGCT, pulmonary vs. NPVM, and the amplitude of serum tumor markers. We identified groups of patients according to the level of tumor marker elevation with cutoff points of AFP 20,000 and hCG 200,000. Results: Mean age 29, mean AFP 8,283, mean hCG 185,667. 24% had PMNSGCT, 48% NPVM, 11% AFP>20,000, and 25% hCG>200,000. When hCG was analyzed as a continuous variable, every 10,000 unit increase in hCG caused the hazard of progression to increase by 1% (p value 0.01). Patients with NPVM had significantly worse PFS. NPVM with elevated hCG had worse outcome than NPVM with normal hCG. This did not correlate as well with AFP. PFS was worse with NPVM than elevated pre-chemotherapy tumor markers. Multiple different criteria for poor risk disease carried significantly worse impact on PFS and OS when compared to having a single criterion for poor risk disease. Conclusions: Our data indicate that patients with NPVM or more than one criteria for PRGCT have a worse outcome compared to other PRGCT subgroups. [Table: see text]

scholarly journals A Case of Nongerminomatous Germ Cell Tumor of the Pineal Region: Risks and Advantages of Biopsy by Endoscopic Approach

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Mauro Dobran ◽  
Davide Nasi ◽  
Fabrizio Mancini ◽  
Maurizio Gladi ◽  
Massimo Scerrati
Keyword(s):  
Germ Cell ◽  
Germ Cell Tumor ◽  
Obstructive Hydrocephalus ◽  
Pineal Region ◽  
Cell Tumor ◽  
Third Ventriculostomy ◽  
Beta Hcg ◽  
Beta Human Chorionic Gonadotropin ◽  
Intracerebral Tumor ◽  
Mass Expansion

A 21-year-old male was admitted to our department with headache and drowsiness. CT scan and MRI revealed acute obstructive hydrocephalus caused by a pineal region mass. The serum and CSF levels of beta-human chorionic gonadotropin (beta-hCG) were 215 IU/L and 447 IU/L, respectively, while levels of alpha-fetoprotein (AFP) were normal. A germ cell tumor (GCT) was suspected, and the patient underwent endoscopic third ventriculostomy (ETV) with biopsy. After four days from surgery, the tumor bled with mass expansion and ETV stoma occlusion; thus, a ventriculoperitoneal shunt was positioned. After ten months, the tumor metastasized to the thorax and abdomen with progression of intracerebral tumor mass. Despite the aggressive nature of this tumor, ETV remains a valid approach for a pineal region mass, but in case of GCT, the risk of bleeding should be taken into account, during and after the surgical procedure.

scholarly journals Retroperitoneal Leiomyosarcoma Associated with an Elevated β-HCG Serum Level Mimicking Extragonadal Germ Cell Tumor

Sarcoma ◽  
2000 ◽  
Vol 4 (4) ◽  
pp. 179-181 ◽  
Author(s):  
Michael Froehner ◽  
Hans-Juergen Gaertner ◽  
Andreas Manseck ◽  
Sven Oehlschlaeger ◽  
Manfred P. Wirth
Keyword(s):  
Serum Level ◽  
Germ Cell ◽  
Tumor Markers ◽  
Germ Cell Tumor ◽  
Germ Cell Tumors ◽  
Soft Tissue Sarcomas ◽  
Retroperitoneal Tumor ◽  
Cell Tumor ◽  
Β Hcg ◽  
Primary Retroperitoneal

Patient.A 65-year-old man was admitted with a large primary retroperitoneal tumor and an increased β-human chorionic gonadotropin (β-HCG) serum level. A germ cell tumor was suspected; however, a computed tomography-guided biopsy failed to enable tumor classification. After two courses of chemotherapy, the β-HCG serum level had returned to the normal level and a diagnostic laparotomy with incisional biopsy was performed. The immunohistochemical examination of the specimen identified the tumor as a retroperitoneal pleomorphic leiomyosarcoma.Discussion.Tumor markers play only a marginal role in the work-up of patients with soft tissue sarcomas. In men with suspected retroperitoneal sarcomas, however, the determination of germ cell tumor markers occasionally enables a preoperative distinguishing of primary retroperitoneal germ cell tumors with considerable consequences for management. In this setting, a retroperitoneal tumor associated with a moderately elevated β-HCG is a diagnostic dilemma, and surgeons should be aware of the pitfall of a β-HCG-producing leiomyosarcoma in the differential diagnosis.

A need for cautious interpretation of elevated serum germ cell tumor markers in children. Review and own experiences

2015 ◽  
Vol 9 (9) ◽  
pp. 923-932 ◽  
Author(s):  
Elzbieta Drozynska ◽  
Ewa Bien ◽  
Katarzyna Polczynska ◽  
Joanna Stefanowicz ◽  
Beata Zalewska-Szewczyk ◽  
...  
Keyword(s):  
Germ Cell ◽  
Tumor Markers ◽  
Germ Cell Tumor ◽  
Elevated Serum ◽  
Cell Tumor ◽  
Cautious Interpretation

Successful Combination Chemotherapy (Cisplatinum, Vinblastine, and Bleomycin) against Peritoneal Dissemination of Intracranial Germ Cell Tumor

Neurosurgery ◽  
1986 ◽  
Vol 18 (6) ◽  
pp. 802-804 ◽  
Author(s):  
Eiji Kumura ◽  
Norio Arita ◽  
Toru Hayakawa ◽  
Yukitaka Ushio ◽  
Hiroyuki Nakata ◽  
...  
Keyword(s):  
Germ Cell ◽  
Germ Cell Tumor ◽  
Combination Chemotherapy ◽  
Peritoneal Dissemination ◽  
Germ Cell Tumors ◽  
Cell Tumor ◽  
Intracranial Germ Cell Tumor ◽  
Computed Tomographic ◽  
The Third ◽  
Intracranial Germ Cell Tumors

Abstract We found combination chemotherapy with cisplatinum, vinblastine, and bleomycin (PVB therapy) effective in the treatment of a patient with a pineal germ cell tumor with peritoneal dissemination. The metastatic complication may have been attributable to the ventriculoperitoneal shunt tube. After the first course of PVB therapy, the disseminated tumors were decreased in size; no residual tumors were detected after the third course by laparoscopic examination, computed tomographic scanning, or echogram. Our results suggest that combined PVB therapy is effective in the treatment of extraneural metastasis from intracranial germ cell tumors. (18:802-804, 1986)

scholarly journals Analysis of cytology of germ cell tumors with histopathological and serum tumor marker correlation: a tertiary care centre experience

2019 ◽  
Vol 7 (11) ◽  
pp. 4084
Author(s):  
Sindhu Nair P. ◽  
Jayasree Kattoor ◽  
Nileena Nayak ◽  
Preethi T. R.
Keyword(s):  
Germ Cell ◽  
Tumor Markers ◽  
Germ Cell Tumor ◽  
Tertiary Care ◽  
Previous History ◽  
Germ Cell Tumors ◽  
Cell Tumor ◽  
Difficult Case ◽  
Serum Tumor Markers ◽  
Residual Neoplasm

Background: Germ cell tumors are found primarily in children and young adults usually arising from gonads and rarely from extragonadal sites like mediastinum, retroperitoneum, pineal gland and sacrococcygeal region. Involvement of lymphnodes or bodycavities (pleural/peritoneal cavity) is usually associated with metastatic disease.Methods: This is a retrospective analysis of 96 cases of germ cell tumor for which a primary diagnosis of germ cell tumor was given by cytology from primary and metastatic sites. The study period is from January 1993- December 2013. Pap stained and Romanowsky stained smears and cell block sections (10cases) were studied. Serum tumor markers (LDH, BetaHCG and AFP) were correlated in all cases along with histopathology in available cases.Results: Among 96 cases 34 were diagnosed as seminoma/dysgerminoma,10 as embryonal carcinoma,9 as yolk sac tumor,6 as teratoma and 2 as mixed germ ell tumor. In 25 cases the cytology report was suggestive of germ cell tumor and in 10 cases malignant cells favouring germ cell tumor. Among the 10 cases the serum markers were high in six of the cases and the clinician after discussing with the pathologist treated them as germ cell tumors. 47 cases had histopathology and it correlated with cytology except in 14 cases which showed no residual neoplasm after chemotherapy. 15 cases expired immediately after the diagnosis or during the course of treatment 12cases were lost to follow up. Rest of the cases have completed the treatment. In our study the serum tumor markers showed a sensitivity of 92.75% and positive predictive value was 71.11%.Conclusions: The study highlights the importance of picking up the diagnosis of germ cell tumors by fine needle aspiration cytology so that patient can get an early diagnosis, effective treatment and a multidisciplinary approach is essential in diagnosing a difficult case of germ cell tumor. Previous history, radiology, clinical features and serum tumor markers all aid in the cytological diagnosis of germ cell tumor.

scholarly journals A rare case of mixed germ cell tumor in a teenage girl: a case report

2017 ◽  
Vol 6 (6) ◽  
pp. 2663
Author(s):  
Faraz S. Vali ◽  
Amit Kyal ◽  
Parul I. Chaudhary ◽  
Sujatha Das ◽  
Aprateem Mukherjee ◽  
...  
Keyword(s):  
Germ Cell ◽  
Germ Cell Tumor ◽  
Embryonal Carcinoma ◽  
Germ Cell Tumors ◽  
Cell Tumor ◽  
Ca 125 ◽  
Gestational Choriocarcinoma ◽  
Mixed Germ Cell Tumor ◽  
Initial Surgery ◽  
Alpha Feto Protein

Germ cell tumors represent only 20% to 25% of all benign and malignant ovarian neoplasms. Mixed germ cell tumors are a rare variety of non–dysgerminomatous germ cell tumors. They contain two or more elements; the most frequent combination being a dysgerminoma and an EST (Endodermal Sinus Tumor). We present a case of malignant mixed germ cell tumor comprising of yolk sac tumor, embryonal carcinoma and choriocarcinoma. A 13-year-old girl presented with a huge 25 x 18 cm mass in abdomen with raised values of CA-125, hCG, AFP (alpha-feto protein) and LDH (lactate dehydrogenase). She underwent laparotomy followed by unilateral salpingoopherectomy and infracolic omentectomy. Histopathology report revealed malignant mixed germ cell tumor comprising predominantly of EST with elements of embryonal carcinoma and non-gestational choriocarcinoma. Following surgery, she was started on adjuvant chemotherapy (Bleomycin, Etoposide and Cisplatin regimen). Mixed germ cell tumor (YST/EST, non-gestational choriocarcinoma and embryonal carcinoma) is a very rare tumor. Careful initial surgery with adequate staging biopsies followed by combination chemotherapy can greatly improve the prognosis of these patients

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