Alphafetoprotein and human chorionic gonadotropin determination in cerebrospinal fluid

An aid to the diagnosis and management of intracranial germ-cell tumors

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✓ The cerebrospinal fluid (CSF) and serum of six patients with histologically verified intracranial germ-cell tumors were assayed serially for the presence of alphafetoprotein (AFP) and the beta subunit of human chorionic gonadotropin (HCG). Two patients had embryonal carcinomas, two had choriocarcinomas, and two had dysgerminomas. The marker profile for a given tumor in either CSF or serum correlated with the histological diagnosis; that is, embryonal carcinoma produced AFP and HCG, choriocarcinoma produced HCG, and dysgerminoma produced no markers. The marker levels in serum and CSF declined with therapy and rose usually prior to the development of overt clinical symptoms if the patient's tumor recurred. A CSF-to-serum gradient of the marker levels was present in three of four patients, and the serum levels were often normal when the CSF values were elevated. Ventricular marker levels were lower than the lumbar levels in two of two patients. The assay of these biological markers is a sensitive indicator of the success of therapy, and the presence of a CSF-to-serum gradient suggests that the major portion of the neoplasm rests within the central nervous system. A histological diagnosis can be inferred without the necessity of surgery in appropriate clinical contexts.

Article Information

Address for Dr. Epstein: Department of Neurosurgery, New York University School of Medicine, New York, New York 10016.Address reprint requests to: Jeffrey C. Allen, M.D., Department of Pediatrics, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, New York 10021.

© AANS, except where prohibited by US copyright law.

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Figures

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    Case 4. Computerized tomography scans illustrating a contrast-enhancing lesion in the region of the pineal gland (left) with evidence of communicating hydrocephalus and periventricular spread of tumor (right).

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    Graph showing serial cerebrospinal fluid (CSF) and serum human chorionic gonadotropin (HCG) levels from Case 1 with embryonal carcinoma. The HCG in lumbar CSF was always higher than the contemporaneous ventricular and serum values, and all levels fell after radiation therapy (RT).

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    Graph showing serial alphafetoprotein (AFP) levels in cerebrospinal fluid (CSF) and serum from Case 2 with mixed embryonal carcinoma and endodermal sinus tumor. All levels initially fell with radiation therapy (RT). Levels of AFP in lumbar CSF rose after 3 months before an increase in serum and ventricular CSF was detected or the CT scan changed. Subsequently the patient received several courses of chemotherapy (CHT), and the marker levels fell transiently. Sx = symptoms.

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