Germinoma natural history

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Natural history

• Malignant transformation of primordial germ cells that inappropriately migrated during development (either failing to migrate into or out of an area) are the originators of germinomas. There is no histologic differentiation whereas nongerminomatous germ cell tumors display a variety of differentiation.

Complications

• Patients with intracranial tumors located in the basal ganglia perform poorly compared with those who have tumors in the suprasellar and pineal regions; they have lower short-term retention of visual and verbal stimuli and full-scale IQs.
• Larger irradiation volume and dose effect the following functions of the brain adversely:
  • Intellectual functions
  • Concept
  • Executive function
  • Memory
  • Decline in neurocognitive function, and performance IQs
• Approximately more than 50% of patients may continue to suffer from endocrine abnormalities such as growth hormone deficiency, growth retardation, hypopituitarism, and hypothyroidism, and may require lifelong hormonal replacement therapy
• Due to surgical resection of tumor or due surgical biopsies the following complications may occur:
  • Poor performance in psychosocial skills
  • Behavioral dysfunction
  • Financial difficulties
  • Lower KPS scores following surgery have been associated with impaired neurocognitive function
• Complications related to chemotherapy may develop
• The surgical morbidity associated with pineal-region tumors is approximately 2-5%. Patients may suffer from the following:
  • Transient movement abnormalities of eyes
• Ataxia
• Cognitive dysfunction.
• Brain atrophy
• Multifocal encephalomalacia
• Leukoencephalopathy
• Focal necrosis
• Cerebrovascular occlusion
• The incidence of secondary cancer is approximately 6%, in patients with intracranial tumors. The risk of death due to malignancy is approximately 16%. Radiation therapy and chemotherapy may both promote the development of secondary cancers such as acute myeloid leukemia and radiation-induced brain neoplasms.

Prognosis

• Generally, germinomas are associated with an excellent prognosis. Intracranial germinomas have a reported 90% survival to five years after diagnosis.The 10-year survival of germinomas is 70%.

The prognosis of various germ cell tumors is shown below in a tabular form:

Type of tumor	5-year survival rate
Germinoma	70-90%
Mixed germ cell tumors	60-80%
Nongerminomatous germ cell tumors	30-50%

References

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