Intracranial germ-cell tumors in children

View More View Less
  • 1 Divisions of Neurosurgery, Neuropathology, and Oncology, The Hospital for Sick Children and the University of Toronto, Toronto, Ontario, Canada
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00
Print or Print + Online

✓ All patients with confirmed intracranial germ-cell tumors treated at the Hospital of Sick Children during the period January, 1952, to December, 1989, were reviewed. Of the 51 tumors reviewed, 16 were located in the suprasellar region, 32 in the pineal region, and three in both the pineal and the suprasellar regions. Forty-nine patients underwent surgical resection which was total in seven and partial in 20, and consisted of a biopsy in 22. Two patients were managed on the basis of serum and cerebrospinal fluid markers. Surgical tools such as the operating microscope, the ultrasonic surgical aspirator, and the laser beam allowed safe debulking and removal of the deep-seated tumors in the pineal region. There were no operative deaths in the 36 patients treated since 1972, who included 23 with pineal tumors. Twenty-five patients with germinomas received radiotherapy and had a 5-year survival rate of 85.1%. Thirteen patients with non-germinoma germ-cell tumors received radiotherapy and had a 5-year survival rate of 45.5%. On the basis of this review, the authors recommend resection of pineal and suprasellar germ-cell tumors in order to firmly establish an accurate histological diagnosis to guide the extent of adjuvant therapy. In the case of a pure germinoma without evidence of dissemination, adjuvant therapy consists only of local radiotherapy. On the other hand, for malignant non-germinoma germ-cell tumors, adjuvant therapy must include chemotherapy as well as craniospinal axis radiotherapy.

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00

Contributor Notes

Address reprint requests to: Harold J. Hoffman, M.D., Division of Neurosurgery, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada.
  • 1.

    Abay EO II, , Laws ER Jr, & Grado GL, et al: Pineal tumors in children and adolescents. Treatment by CSF shunting and radiotherapy. J Neurosurg 55:889895, 1981 Abay EO II, Laws ER Jr, Grado GL, et al: Pineal tumors in children and adolescents. Treatment by CSF shunting and radiotherapy. J Neurosurg 55:889–895, 1981

    • Search Google Scholar
    • Export Citation
  • 2.

    Allen JC, , Bosl G, & Walker R: Chemotherapy trials in recurrent primary intracranial germ cell tumors. J Neurooncol 3:147152, 1985 Allen JC, Bosl G, Walker R: Chemotherapy trials in recurrent primary intracranial germ cell tumors. J Neurooncol 3:147–152, 1985

    • Search Google Scholar
    • Export Citation
  • 3.

    Allen JC, , Kim JH, & Packer RJ: Neoadjuvant chemotherapy for newly diagnosed germ-cell tumors of the central nervous system. J Neurosurg 67:6570, 1987 Allen JC, Kim JH, Packer RJ: Neoadjuvant chemotherapy for newly diagnosed germ-cell tumors of the central nervous system. J Neurosurg 67:65–70, 1987

    • Search Google Scholar
    • Export Citation
  • 4.

    Apuzzo MLJ, , Chandrasoma PT, & Zelman V, et al: Computed tomographic guidance stereotaxis in the management of lesions of the third ventricular region. Neurosurgery 15:502508, 1984 Apuzzo MLJ, Chandrasoma PT, Zelman V, et al: Computed tomographic guidance stereotaxis in the management of lesions of the third ventricular region. Neurosurgery 15:502–508, 1984

    • Search Google Scholar
    • Export Citation
  • 5.

    Arita N, , Bitoh S, & Ushio Y, et al: Primary pineal endodermal sinus tumor with elevated serum and CSF alpha-fetoprotein levels. Case report. J Neurosurg 53:244248, 1980 Arita N, Bitoh S, Ushio Y, et al: Primary pineal endodermal sinus tumor with elevated serum and CSF alpha-fetoprotein levels. Case report. J Neurosurg 53:244–248, 1980

    • Search Google Scholar
    • Export Citation
  • 6.

    Arita N, , Awash Y, & Hayakawa T, et al: Role of markers in the management of primary intracranial germ cell tumors. Prog Exp Tumor Res 30:289295, 1987 Arita N, Awash Y, Hayakawa T, et al: Role of markers in the management of primary intracranial germ cell tumors. Prog Exp Tumor Res 30:289–295, 1987

    • Search Google Scholar
    • Export Citation
  • 7.

    Asai A, , Matsutani M, & Takakura K, et al: Subacute brain atrophy after radiation therapy for malignant brain tumors. Cancer 63:19621974, 1989 Asai A, Matsutani M, Takakura K, et al: Subacute brain atrophy after radiation therapy for malignant brain tumors. Cancer 63:1962–1974, 1989

    • Search Google Scholar
    • Export Citation
  • 8.

    Camins MB, & Mount LA: Primary suprasellar atypical teratoma. Brain 97:447456, 1974 Camins MB, Mount LA: Primary suprasellar atypical teratoma. Brain 97:447–456, 1974

    • Search Google Scholar
    • Export Citation
  • 9.

    Casentini L, , Colombo F, & Pozza F, et al: Combined radiosurgery and external radiotherapy of intracranial germinomas. Surg Neurol 34:7986, 1990 Casentini L, Colombo F, Pozza F, et al: Combined radiosurgery and external radiotherapy of intracranial germinomas. Surg Neurol 34:79–86, 1990

    • Search Google Scholar
    • Export Citation
  • 10.

    Chang CG, , Kageyama N, & Kobayashi T, et al: Pineal tumors: clinical diagnosis, with special emphasis on the significance of pineal calcification. Neurosurgery 8:656668, 1981 Chang CG, Kageyama N, Kobayashi T, et al: Pineal tumors: clinical diagnosis, with special emphasis on the significance of pineal calcification. Neurosurgery 8:656–668, 1981

    • Search Google Scholar
    • Export Citation
  • 11.

    Chapman PH, & Linggood RM: The management of pineal area tumors: a recent reappraisal. Cancer 46:12531257, 1980 Chapman PH, Linggood RM: The management of pineal area tumors: a recent reappraisal. Cancer 46:1253–1257, 1980

    • Search Google Scholar
    • Export Citation
  • 12.

    Cohen DN, , Steinberg M, & Buchwald R: Suprasellar germinomas: diagnostic confusion with optic gliomas. Case report. J Neurosurg 41:490493, 1974 Cohen DN, Steinberg M, Buchwald R: Suprasellar germinomas: diagnostic confusion with optic gliomas. Case report. J Neurosurg 41:490–493, 1974

    • Search Google Scholar
    • Export Citation
  • 13.

    Conway LW: Stereotaxic diagnosis and treatment of intracranial tumors including an initial experience with cryosurgery for pinealomas. J Neurosurg 38:453460, 1973 Conway LW: Stereotaxic diagnosis and treatment of intracranial tumors including an initial experience with cryosurgery for pinealomas. J Neurosurg 38:453–460, 1973

    • Search Google Scholar
    • Export Citation
  • 14.

    Dandy WE: An operation for the removal of pineal tumors. Surg Gynecol Obstet 33:113119, 1921 Dandy WE: An operation for the removal of pineal tumors. Surg Gynecol Obstet 33:113–119, 1921

    • Search Google Scholar
    • Export Citation
  • 15.

    Dandy WE: Operative experiences in cases of pineal tumor. Arch Surg 33:1946, 1936 Dandy WE: Operative experiences in cases of pineal tumor. Arch Surg 33:19–46, 1936

    • Search Google Scholar
    • Export Citation
  • 16.

    Davidoff LM: Some considerations in the therapy of pineal tumors. Bull NY Acad Med 43:537561, 1967 Davidoff LM: Some considerations in the therapy of pineal tumors. Bull NY Acad Med 43:537–561, 1967

    • Search Google Scholar
    • Export Citation
  • 17.

    Davis PC, , Hoffman JC, & Pearl GS, et al: CT evaluation of effects of cranial radiation therapy in children. AJNR 7:639644, 1986 Davis PC, Hoffman JC, Pearl GS, et al: CT evaluation of effects of cranial radiation therapy in children. AJNR 7:639–644, 1986

    • Search Google Scholar
    • Export Citation
  • 18.

    Hawkins EP, , Finegold MJ, & Hawkins HK, et al: Non-germinomatous malignant germ cell tumors in children: a review of 89 cases from the Pediatric Oncology Group. Cancer 58:25792584, 1986 Hawkins EP, Finegold MJ, Hawkins HK, et al: Non-germinomatous malignant germ cell tumors in children: a review of 89 cases from the Pediatric Oncology Group. Cancer 58:2579–2584, 1986

    • Search Google Scholar
    • Export Citation
  • 19.

    Hirsch JF, , Renier D, & Czernichow P, et al: Medulloblastoma in childhood. Survival and functional results. Acta Neurochir 48:115, 1979 Hirsch JF, Renier D, Czernichow P, et al: Medulloblastoma in childhood. Survival and functional results. Acta Neurochir 48:1–15, 1979

    • Search Google Scholar
    • Export Citation
  • 20.

    Hoffman HJ, , Yoshida M, & Becker LE: Experience with pineal region tumor in children. Neurol Res 6:107112, 1984 Hoffman HJ, Yoshida M, Becker LE: Experience with pineal region tumor in children. Neurol Res 6:107–112, 1984

    • Search Google Scholar
    • Export Citation
  • 21.

    Jamieson KG: Excision of pineal tumors. J Neurosurg 35:550553, 1971 Jamieson KG: Excision of pineal tumors. J Neurosurg 35:550–553, 1971

    • Search Google Scholar
    • Export Citation
  • 22.

    The Japanese Intracranial Germ Cell Tumor Study Group: Cisplatin, vinblastine, bleomycin (PVB) combination chemotherapy in the treatment of intracranial malignant germ cell tumors: a preliminary report of phase II study. Jpn J Cancer Clin 32:13871393, 1986 The Japanese Intracranial Germ Cell Tumor Study Group: Cisplatin, vinblastine, bleomycin (PVB) combination chemotherapy in the treatment of intracranial malignant germ cell tumors: a preliminary report of phase II study. Jpn J Cancer Clin 32:1387–1393, 1986

    • Search Google Scholar
    • Export Citation
  • 23.

    Jenkin RDT, , Simpson WJK, & Keen CW: Pineal and suprasellar germinomas. Results of radiation treatment. J Neurosurg 48:99107, 1978 Jenkin RDT, Simpson WJK, Keen CW: Pineal and suprasellar germinomas. Results of radiation treatment. J Neurosurg 48:99–107, 1978

    • Search Google Scholar
    • Export Citation
  • 24.

    Jennings MT, , Gelman R, & Hochberg F: Intracranial germ-cell tumors: natural history and pathogenesis. J Neurosurg 63:155167, 1985 Jennings MT, Gelman R, Hochberg F: Intracranial germ-cell tumors: natural history and pathogenesis. J Neurosurg 63:155–167, 1985

    • Search Google Scholar
    • Export Citation
  • 25.

    Kageyama N: Ectopic pinealoma in the region of the optic chiasm. Report of five cases. J Neurosurg 35:755759, 1971 Kageyama N: Ectopic pinealoma in the region of the optic chiasm. Report of five cases. J Neurosurg 35:755–759, 1971

    • Search Google Scholar
    • Export Citation
  • 26.

    Kida Y, , Kobayashi T, & Yoshida J, et al: Chemotherapy with cisplatin for AFP-secreting germ-cell tumors of the central nervous system. J Neurosurg 65:470475, 1986 Kida Y, Kobayashi T, Yoshida J, et al: Chemotherapy with cisplatin for AFP-secreting germ-cell tumors of the central nervous system. J Neurosurg 65:470–475, 1986

    • Search Google Scholar
    • Export Citation
  • 27.

    Kurman RJ, , Scardino PT, & McIntire KR, et al: Cellular localization of alphafetoprotein and human chorionic gonadotropin in germ cell tumors of testis using an indirect immunoperoxidase technique: a new approach to classification utilizing tumor markers. Cancer 40:21362151, 1977 Kurman RJ, Scardino PT, McIntire KR, et al: Cellular localization of alphafetoprotein and human chorionic gonadotropin in germ cell tumors of testis using an indirect immunoperoxidase technique: a new approach to classification utilizing tumor markers. Cancer 40:2136–2151, 1977

    • Search Google Scholar
    • Export Citation
  • 28.

    Lewis I, , Baxter DW, & Stratford JG: Atypical teratomas of the pineal. Can Med Assoc J 89:103110, 1963 Lewis I, Baxter DW, Stratford JG: Atypical teratomas of the pineal. Can Med Assoc J 89:103–110, 1963

    • Search Google Scholar
    • Export Citation
  • 29.

    Linstadt D, , Wara WM, & Edwards MSB, et al: Radiotherapy of primary intracranial germinomas. The case against routine craniospinal irradiation. Int J Radiat Oncol Biol Phys 15:291297, 1988 Linstadt D, Wara WM, Edwards MSB, et al: Radiotherapy of primary intracranial germinomas. The case against routine craniospinal irradiation. Int J Radiat Oncol Biol Phys 15:291–297, 1988

    • Search Google Scholar
    • Export Citation
  • 30.

    Matsutani M, , Takakura K, & Sano K: Primary intracranial germ cell tumors: pathology and treatment. Prog Exp Tumor Res 30:307312, 1987 Matsutani M, Takakura K, Sano K: Primary intracranial germ cell tumors: pathology and treatment. Prog Exp Tumor Res 30:307–312, 1987

    • Search Google Scholar
    • Export Citation
  • 31.

    Naganuma H, , Inoue HK, & Nakamura M, et al: Localization of carcinoembryonie antigen in mature intracranial teratomas. J Neurosurg 62:870873, 1985 Naganuma H, Inoue HK, Nakamura M, et al: Localization of carcinoembryonie antigen in mature intracranial teratomas. J Neurosurg 62:870–873, 1985

    • Search Google Scholar
    • Export Citation
  • 32.

    Nishiyama RH, , Batsakis JG, & Weaver DK, et al: Germinal neoplasms of the central nervous system. Arch Surg 93:342347, 1966 Nishiyama RH, Batsakis JG, Weaver DK, et al: Germinal neoplasms of the central nervous system. Arch Surg 93:342–347, 1966

    • Search Google Scholar
    • Export Citation
  • 33.

    Nørgaard-Pedersen B, , Lindholm J, & Albrechtsen R, et al: Alpha-fetoprotein and human chorionic gonadotropin in a patient with a primary intracranial germ cell tumor. Cancer 41:23152320, 1978 Nørgaard-Pedersen B, Lindholm J, Albrechtsen R, et al: Alpha-fetoprotein and human chorionic gonadotropin in a patient with a primary intracranial germ cell tumor. Cancer 41:2315–2320, 1978

    • Search Google Scholar
    • Export Citation
  • 34.

    Packer RJ, , Sutton LN, & Rosenstock JG, et al: Pineal region tumor of childhood. Pediatrics 74:97102, 1984 Packer RJ, Sutton LN, Rosenstock JG, et al: Pineal region tumor of childhood. Pediatrics 74:97–102, 1984

    • Search Google Scholar
    • Export Citation
  • 35.

    Page LK: The intratentorial-supracerebellar exposure of tumors in the pineal area. Neurosurgery 1:3640, 1977 Page LK: The intratentorial-supracerebellar exposure of tumors in the pineal area. Neurosurgery 1:36–40, 1977

    • Search Google Scholar
    • Export Citation
  • 36.

    Paine JT, , Handa H, & Yamasaki T, et al: Suprasellar germinoma with shunt metastasis: report of a case with an immunohistochemical characterization of the lymphocyte subpopulations. Surg Neurol 25:5561, 1986 Paine JT, Handa H, Yamasaki T, et al: Suprasellar germinoma with shunt metastasis: report of a case with an immunohistochemical characterization of the lymphocyte subpopulations. Surg Neurol 25:55–61, 1986

    • Search Google Scholar
    • Export Citation
  • 37.

    Painter MJ, , Chutorian AM, & Hilal S: Cerebrovasculopathy following irradiation in childhood. Neurology 25:189194, 1975 Painter MJ, Chutorian AM, Hilal S: Cerebrovasculopathy following irradiation in childhood. Neurology 25:189–194, 1975

    • Search Google Scholar
    • Export Citation
  • 38.

    Pecker J, , Scarabin J, & Ballee B, et al: Treatment of tumors in the pineal region: value of stereotactic biopsy. Surg Neurol 12:341348, 1979 Pecker J, Scarabin J, Ballee B, et al: Treatment of tumors in the pineal region: value of stereotactic biopsy. Surg Neurol 12:341–348, 1979

    • Search Google Scholar
    • Export Citation
  • 39.

    Pomarede R, , Czernichow P, & Finidori J, et al: Endocrine aspects and tumoral markers in intracranial germinoma: an attempt to delineate the diagnostic procedure in 14 patients. J Pediatr 101:374378, 1982 Pomarede R, Czernichow P, Finidori J, et al: Endocrine aspects and tumoral markers in intracranial germinoma: an attempt to delineate the diagnostic procedure in 14 patients. J Pediatr 101:374–378, 1982

    • Search Google Scholar
    • Export Citation
  • 40.

    Rao YTR, , Medini E, & Haselow RE, et al: Pineal and ectopic pineal tumors: the role of radiation therapy. Cancer 48:708713, 1981 Rao YTR, Medini E, Haselow RE, et al: Pineal and ectopic pineal tumors: the role of radiation therapy. Cancer 48:708–713, 1981

    • Search Google Scholar
    • Export Citation
  • 41.

    Reid WS, & Clark WK: Comparison of the infratentorial and transtentorial approaches to the pineal region. Neurosurgery 3:18, 1978 Reid WS, Clark WK: Comparison of the infratentorial and transtentorial approaches to the pineal region. Neurosurgery 3:1–8, 1978

    • Search Google Scholar
    • Export Citation
  • 42.

    Rubin P, & Kramer S: Ectopic pinealoma: a radiocurable neuroendocrinologic entity. Radiology 85:512523, 1965 Rubin P, Kramer S: Ectopic pinealoma: a radiocurable neuroendocrinologic entity. Radiology 85:512–523, 1965

    • Search Google Scholar
    • Export Citation
  • 43.

    Russell WO, & Sachs E: Pinealoma: a clinicopathological study of seven cases with a review of the literature. Arch Pathol 35:869888, 1943 Russell WO, Sachs E: Pinealoma: a clinicopathological study of seven cases with a review of the literature. Arch Pathol 35:869–888, 1943

    • Search Google Scholar
    • Export Citation
  • 44.

    Sano K: Pinealoma in children. Childs Brain 2:6772, 1976 Sano K: Pinealoma in children. Childs Brain 2:67–72, 1976

  • 45.

    Sano K, & Matsutani M: Pinealoma (germinoma) treated by direct surgery and postoperative irradiation. A long-term follow-up. Childs Brain 8:8197, 1981 Sano K, Matsutani M: Pinealoma (germinoma) treated by direct surgery and postoperative irradiation. A long-term follow-up. Childs Brain 8:81–97, 1981

    • Search Google Scholar
    • Export Citation
  • 46.

    Shibamoto Y, , Abe M, & Yamashita J, et al: Treatment results of intracranial germinomas as a function of the irradiated volume. Int J Radiat Oncol Biol Phys 15:285290, 1988 Shibamoto Y, Abe M, Yamashita J, et al: Treatment results of intracranial germinomas as a function of the irradiated volume. Int J Radiat Oncol Biol Phys 15:285–290, 1988

    • Search Google Scholar
    • Export Citation
  • 47.

    Simson LR, , Lampe I, & Abell MR: Suprasellar germinomas. Cancer 22:533544, 1968 Simson LR, Lampe I, Abell MR: Suprasellar germinomas. Cancer 22:533–544, 1968

    • Search Google Scholar
    • Export Citation
  • 48.

    Stein BM: The infratentorial supracerebellar approach to pineal lesions. J Neurosurg 35:197202, 1971 Stein BM: The infratentorial supracerebellar approach to pineal lesions. J Neurosurg 35:197–202, 1971

    • Search Google Scholar
    • Export Citation
  • 49.

    Takakura K: Intracranial germ cell tumors. Clin Neurosurg 32:429444, 1985 Takakura K: Intracranial germ cell tumors. Clin Neurosurg 32:429–444, 1985

    • Search Google Scholar
    • Export Citation
  • 50.

    Wara WM, , Jenkin RD, & Evans A, et al: Tumors of the pineal and suprasellar region: Children's Cancer Study Group treatment results 1960–1975. A report from the Children's Cancer Study Group. Cancer 43:698701, 1979 Wara WM, Jenkin RD, Evans A, et al: Tumors of the pineal and suprasellar region: Children's Cancer Study Group treatment results 1960–1975. A report from the Children's Cancer Study Group. Cancer 43:698–701, 1979

    • Search Google Scholar
    • Export Citation
  • 51.

    Williams SD, , Einhorn LH, & Greco FA, et al: VP-16-213 salvage therapy for refractory germinal neoplasms. Cancer 46:21542158, 1980 Williams SD, Einhorn LH, Greco FA, et al: VP-16-213 salvage therapy for refractory germinal neoplasms. Cancer 46:2154–2158, 1980

    • Search Google Scholar
    • Export Citation
  • 52.

    Wilson ER, , Takei Y, & Bikoff WT, et al: Abnormal metastases of primary intracranial yolk sac tumors through ventriculoperitoneal shunts: report of three cases. Neurosurgery 5:356364, 1979 Wilson ER, Takei Y, Bikoff WT, et al: Abnormal metastases of primary intracranial yolk sac tumors through ventriculoperitoneal shunts: report of three cases. Neurosurgery 5:356–364, 1979

    • Search Google Scholar
    • Export Citation
  • 53.

    Zülch KJ: Atlas of Gross Neurosurgical Pathology. Berlin: Springer-Verlag, 1975, pp 48 Zülch KJ: Atlas of Gross Neurosurgical Pathology. Berlin: Springer-Verlag, 1975, pp 48

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 643 278 34
Full Text Views 320 21 6
PDF Downloads 116 10 3
EPUB Downloads 0 0 0