Germinoma laboratory tests: Difference between revisions
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==Overview== | ==Overview== | ||
An elevated concentration of AFP and beta-hCG in the serum and CSF, and CSF cytology to detect malignant cells is diagnostic of intracranial germ cell tumors. In patients in whom endoscopic biopsy is not considered possible, detection of elevated tumor markers may be sufficient for diagnosis. | An elevated concentration of [[AFP]] and [[beta-hCG]] in the [[serum]] and [[CSF]], and CSF cytology to detect [[malignant]] cells is diagnostic of intracranial [[germ cell tumors]]. In patients in whom endoscopic [[biopsy]] is not considered possible, detection of elevated tumor markers may be sufficient for diagnosis. | ||
==Laboratory Findings== | ==Laboratory Findings== | ||
The following tests are done for intracranial germ cell tumors: | The following tests are done for intracranial [[germ cell tumors]]: | ||
*CSF cytology to detect malignant cells | *[[CSF cytology]] to detect malignant cells | ||
*Measurement of AFP and beta-hCG in the CSF and serum | *Measurement of AFP and beta-hCG in the CSF and serum | ||
**Tumor marker levels are usually higher in CSF than in serum. In patients in whom endoscopic biopsy is not considered possible, detection of elevated tumor markers may be sufficient for diagnosis. | **Tumor marker levels are usually higher in CSF than in serum. In patients in whom endoscopic biopsy is not considered possible, detection of elevated tumor markers may be sufficient for diagnosis. | ||
**Measurement of beta-hCG and AFP in the CSF is more sensitive than serum levels in detecting abnormalities. However, due to discordant serum and CSF tumor marker results that were observed, both serum and CSF tumor markers should be obtained in the absence of clinical contraindications. Lumbar CSF is considered more accurate for tumor markers and cytology than ventricular CSF. | **Measurement of beta-hCG and AFP in the CSF is more sensitive than serum levels in detecting abnormalities. However, due to discordant serum and CSF tumor marker results that were observed, both serum and CSF tumor markers should be obtained in the absence of clinical contraindications. Lumbar CSF is considered more accurate for tumor markers and [[cytology]] than [[ventricular]] CSF. | ||
**Tumor markers from ventricular CSF can be used, if a lumbar puncture is contraindicated. | **Tumor markers from ventricular CSF can be used, if a [[lumbar puncture]] is contraindicated.<ref name="pmid18802946">{{cite journal| author=Kim A, Ji L, Balmaceda C, Diez B, Kellie SJ, Dunkel IJ et al.| title=The prognostic value of tumor markers in newly diagnosed patients with primary central nervous system germ cell tumors. | journal=Pediatr Blood Cancer | year= 2008 | volume= 51 | issue= 6 | pages= 768-73 | pmid=18802946 | doi=10.1002/pbc.21741 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18802946 }} </ref><ref name="pmid2039390">{{cite journal| author=Horowitz MB, Hall WA| title=Central nervous system germinomas. A review. | journal=Arch Neurol | year= 1991 | volume= 48 | issue= 6 | pages= 652-7 | pmid=2039390 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2039390 }} </ref> | ||
*Laboratory studies to detect the hormonal dysfunction that may occur in patients with central nervous system (CNS) germinomas are as follows: | *Laboratory studies to detect the hormonal dysfunction that may occur in patients with [[central nervous system]] (CNS) germinomas are as follows: | ||
**Diabetes insipidus | **[[Diabetes insipidus]] | ||
***Serum sodium, serum osmolality, and urine osmolality | ***Serum sodium, serum osmolality, and urine osmolality | ||
**Hypopituitarism | **[[Hypopituitarism]] | ||
***Thyroid function tests, growth hormone levels, cortisol levels | ***[[Thyroid function tests]], [[growth hormone]] levels, cortisol levels | ||
**Gonadal dysfunction | **Gonadal dysfunction | ||
***Testosterone level in males; prolactin level in females | ***[[Testosterone]] level in males; [[prolactin]] level in females | ||
Although elevated alpha-fetoprotein levels may be seen in the germ cell tumors; however, AFP levels may be normally elevated both in serum and CSF of neonates and infants. Alpha-fetoprotein (AFP) levels may be elevated in the following tumors: | Although elevated alpha-fetoprotein levels may be seen in the germ cell tumors; however, AFP levels may be normally elevated both in serum and CSF of neonates and infants. Alpha-fetoprotein (AFP) levels may be elevated in the following tumors: | ||
*Pure endodermal sinus tumor (yolk sac) | *Pure [[endodermal sinus tumor]] (yolk sac) | ||
*Embryonal carcinoma | *[[Embryonal carcinoma]] | ||
*Malignant teratoma. | *Malignant teratoma. | ||
Interpretation of the AFP level must take into account the normal variation seen in this age group. The median AFP levels in CSF, in normal infants, are as follows: | Interpretation of the AFP level must take into account the normal variation seen in this age group. The median AFP levels in CSF, in normal infants, are as follows: | ||
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Usually, pure germinomas and mature teratomas present with normal levels of AFP and beta-hCG in both serum and CSF. However, some histologically confirmed germinomas have elevated beta-hCG levels that are presumed to be due to beta-hCG secreting syncytiotrophoblasts. In beta-hCG secreting syncytiotrophoblasts, elevations of serum beta-hCG are generally limited (<50 IU/L), although some tumors have levels >100 IU/L. | Usually, pure germinomas and mature teratomas present with normal levels of [[AFP]] and [[beta-hCG]] in both [[serum]] and [[CSF]]. However, some histologically confirmed germinomas have elevated beta-hCG levels that are presumed to be due to beta-hCG secreting syncytiotrophoblasts. In beta-hCG secreting syncytiotrophoblasts, elevations of serum beta-hCG are generally limited (<50 IU/L), although some tumors have levels >100 IU/L.<ref name="pmid19636276">{{cite journal| author=Goodwin TL, Sainani K, Fisher PG| title=Incidence patterns of central nervous system germ cell tumors: a SEER Study. | journal=J Pediatr Hematol Oncol | year= 2009 | volume= 31 | issue= 8 | pages= 541-4 | pmid=19636276 | doi=10.1097/MPH.0b013e3181983af5 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19636276 }} </ref><ref name="pmid19329861">{{cite journal| author=Sato K, Takeuchi H, Kubota T| title=Pathology of intracranial germ cell tumors. | journal=Prog Neurol Surg | year= 2009 | volume= 23 | issue= | pages= 59-75 | pmid=19329861 | doi=10.1159/000210053 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19329861 }} </ref><ref>Kleihues, P, and W. K. Cavenee. Pathology and genetics of tumours of the nervous system. Lyon: IARC Press, 2000. Print.</ref><ref name="pmid19329866">{{cite journal| author=Shibamoto Y| title=Management of central nervous system germinoma: proposal for a modern strategy. | journal=Prog Neurol Surg | year= 2009 | volume= 23 | issue= | pages= 119-29 | pmid=19329866 | doi=10.1159/000210058 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19329866 }} </ref><ref name="pmid8083078">{{cite journal| author=Shibamoto Y, Oda Y, Yamashita J, Takahashi M, Kikuchi H, Abe M| title=The role of cerebrospinal fluid cytology in radiotherapy planning for intracranial germinoma. | journal=Int J Radiat Oncol Biol Phys | year= 1994 | volume= 29 | issue= 5 | pages= 1089-94 | pmid=8083078 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8083078 }} </ref> | ||
The relevant tumor marker findings is shown below in a tabular form: | The relevant tumor marker findings is shown below in a tabular form: | ||
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==References== | ==References== | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Simrat Sarai, M.D. [2]
Overview
An elevated concentration of AFP and beta-hCG in the serum and CSF, and CSF cytology to detect malignant cells is diagnostic of intracranial germ cell tumors. In patients in whom endoscopic biopsy is not considered possible, detection of elevated tumor markers may be sufficient for diagnosis.
Laboratory Findings
The following tests are done for intracranial germ cell tumors:
- CSF cytology to detect malignant cells
- Measurement of AFP and beta-hCG in the CSF and serum
- Tumor marker levels are usually higher in CSF than in serum. In patients in whom endoscopic biopsy is not considered possible, detection of elevated tumor markers may be sufficient for diagnosis.
- Measurement of beta-hCG and AFP in the CSF is more sensitive than serum levels in detecting abnormalities. However, due to discordant serum and CSF tumor marker results that were observed, both serum and CSF tumor markers should be obtained in the absence of clinical contraindications. Lumbar CSF is considered more accurate for tumor markers and cytology than ventricular CSF.
- Tumor markers from ventricular CSF can be used, if a lumbar puncture is contraindicated.[1][2]
- Laboratory studies to detect the hormonal dysfunction that may occur in patients with central nervous system (CNS) germinomas are as follows:
- Diabetes insipidus
- Serum sodium, serum osmolality, and urine osmolality
- Hypopituitarism
- Thyroid function tests, growth hormone levels, cortisol levels
- Gonadal dysfunction
- Testosterone level in males; prolactin level in females
- Diabetes insipidus
Although elevated alpha-fetoprotein levels may be seen in the germ cell tumors; however, AFP levels may be normally elevated both in serum and CSF of neonates and infants. Alpha-fetoprotein (AFP) levels may be elevated in the following tumors:
- Pure endodermal sinus tumor (yolk sac)
- Embryonal carcinoma
- Malignant teratoma.
Interpretation of the AFP level must take into account the normal variation seen in this age group. The median AFP levels in CSF, in normal infants, are as follows:
| Age | AFP levels |
|---|---|
|
|
|
|
|
|
Usually, pure germinomas and mature teratomas present with normal levels of AFP and beta-hCG in both serum and CSF. However, some histologically confirmed germinomas have elevated beta-hCG levels that are presumed to be due to beta-hCG secreting syncytiotrophoblasts. In beta-hCG secreting syncytiotrophoblasts, elevations of serum beta-hCG are generally limited (<50 IU/L), although some tumors have levels >100 IU/L.[3][4][5][6][7] The relevant tumor marker findings is shown below in a tabular form:
| Tumor marker | Features |
|---|---|
|
|
|
|
|
|
References
- ↑ Kim A, Ji L, Balmaceda C, Diez B, Kellie SJ, Dunkel IJ; et al. (2008). "The prognostic value of tumor markers in newly diagnosed patients with primary central nervous system germ cell tumors". Pediatr Blood Cancer. 51 (6): 768–73. doi:10.1002/pbc.21741. PMID 18802946.
- ↑ Horowitz MB, Hall WA (1991). "Central nervous system germinomas. A review". Arch Neurol. 48 (6): 652–7. PMID 2039390.
- ↑ Goodwin TL, Sainani K, Fisher PG (2009). "Incidence patterns of central nervous system germ cell tumors: a SEER Study". J Pediatr Hematol Oncol. 31 (8): 541–4. doi:10.1097/MPH.0b013e3181983af5. PMID 19636276.
- ↑ Sato K, Takeuchi H, Kubota T (2009). "Pathology of intracranial germ cell tumors". Prog Neurol Surg. 23: 59–75. doi:10.1159/000210053. PMID 19329861.
- ↑ Kleihues, P, and W. K. Cavenee. Pathology and genetics of tumours of the nervous system. Lyon: IARC Press, 2000. Print.
- ↑ Shibamoto Y (2009). "Management of central nervous system germinoma: proposal for a modern strategy". Prog Neurol Surg. 23: 119–29. doi:10.1159/000210058. PMID 19329866.
- ↑ Shibamoto Y, Oda Y, Yamashita J, Takahashi M, Kikuchi H, Abe M (1994). "The role of cerebrospinal fluid cytology in radiotherapy planning for intracranial germinoma". Int J Radiat Oncol Biol Phys. 29 (5): 1089–94. PMID 8083078.