Germinoma other imaging findings: Difference between revisions
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==Overview== | ==Overview== | ||
Biopsy may be helpful in the diagnosis of germinoma. Findings on biopsy diagnostic of germinoma include undifferentiated, uniform large cells with abundant glycogen-rich cytoplasm arranged in nests separated by bands of connective tissue along trophoblastic lines. | Biopsy may be helpful in the diagnosis of germinoma. Findings on biopsy diagnostic of germinoma include undifferentiated, uniform large cells with abundant glycogen-rich cytoplasm arranged in nests separated by bands of connective tissue along trophoblastic lines.<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> | ||
==Other Imaging Findings== | ==Other Imaging Findings== | ||
===Biopsy=== | ===Biopsy=== | ||
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*Histologic examination is needed to ascertain the histologic subtype and to establish a definitive diagnosis of an intracranial germ cell tumors (GCT). A tissue sample should be obtained unless surgery cannot be performed safely. Surgery to obtain a tissue sample for diagnosis is mandatory for patients with normal CSF and serum AFP and beta-hCG, as a mature teratoma or pure germinoma must be distinguished from other benign and malignant lesions. | *Histologic examination is needed to ascertain the histologic subtype and to establish a definitive diagnosis of an intracranial germ cell tumors (GCT). A tissue sample should be obtained unless surgery cannot be performed safely. Surgery to obtain a tissue sample for diagnosis is mandatory for patients with normal CSF and serum AFP and beta-hCG, as a mature teratoma or pure germinoma must be distinguished from other benign and malignant lesions. | ||
*Only patients with elevated CSF or serum levels of AFP or β-hCG >50-100 IU/ml do not need surgery for the purpose of tissue diagnosis. Diagnosis without tissue biopsy should be considered in the patients with secreting tumors because high postoperative mortality has been reported after resection of such tumors. | *Only patients with elevated CSF or serum levels of AFP or β-hCG >50-100 IU/ml do not need surgery for the purpose of tissue diagnosis. Diagnosis without tissue biopsy should be considered in the patients with secreting tumors because high postoperative mortality has been reported after resection of such tumors. | ||
*An elevated level of AFP in either the CSF or serum is sufficient to classify a tumor as a NGGCT, although tumor tissue is useful for prognostic classification. Patients with a normal AFP but an elevated beta-hCG (>50 IU/L) should undergo surgery if possible to distinguish an immature teratoma or a choriocarcinoma from beta-hCG secreting germinoma, as the former are considered NGGCTs and need more aggressive treatment. | *An elevated level of AFP in either the CSF or serum is sufficient to classify a tumor as a NGGCT, although tumor tissue is useful for prognostic classification. Patients with a normal AFP but an elevated beta-hCG (>50 IU/L) should undergo surgery if possible to distinguish an immature teratoma or a choriocarcinoma from beta-hCG secreting germinoma, as the former are considered NGGCTs and need more aggressive treatment.<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="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="SaranPeoples2008">{{cite journal|last1=Saran|first1=Frank|last2=Peoples|first2=Sharon|title=Pineal Tumors: Germinomas and Non-Germinomatous Germ Cell Tumors|year=2008|pages=310–317|doi=10.1002/9781444300222.ch41}}</ref> | ||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
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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
Biopsy may be helpful in the diagnosis of germinoma. Findings on biopsy diagnostic of germinoma include undifferentiated, uniform large cells with abundant glycogen-rich cytoplasm arranged in nests separated by bands of connective tissue along trophoblastic lines.[1]
Other Imaging Findings
Biopsy
- According to the current recommendations, surgical biopsy for histological confirmation is necessary for all patients with pineal and suprasellar tumors, which is accomplished by means of endoscopic/stereotactic biopsy or open biopsy.
- In comparison to pineal tumors suprasellar tumors are generally more accessible to surgical biopsy.
- Adequate specimen size is important in the diagnosis because in nongerminomatous germ cell tumors (NGGCT), a specimen that is too small may miss a tumor component and thus may not be representative of the actual tumor type.
- Histologic examination is needed to ascertain the histologic subtype and to establish a definitive diagnosis of an intracranial germ cell tumors (GCT). A tissue sample should be obtained unless surgery cannot be performed safely. Surgery to obtain a tissue sample for diagnosis is mandatory for patients with normal CSF and serum AFP and beta-hCG, as a mature teratoma or pure germinoma must be distinguished from other benign and malignant lesions.
- Only patients with elevated CSF or serum levels of AFP or β-hCG >50-100 IU/ml do not need surgery for the purpose of tissue diagnosis. Diagnosis without tissue biopsy should be considered in the patients with secreting tumors because high postoperative mortality has been reported after resection of such tumors.
- An elevated level of AFP in either the CSF or serum is sufficient to classify a tumor as a NGGCT, although tumor tissue is useful for prognostic classification. Patients with a normal AFP but an elevated beta-hCG (>50 IU/L) should undergo surgery if possible to distinguish an immature teratoma or a choriocarcinoma from beta-hCG secreting germinoma, as the former are considered NGGCTs and need more aggressive treatment.[1][2][3]
References
- ↑ 1.0 1.1 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.
- ↑ 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.
- ↑ Saran, Frank; Peoples, Sharon (2008). "Pineal Tumors: Germinomas and Non-Germinomatous Germ Cell Tumors": 310–317. doi:10.1002/9781444300222.ch41.