Abstract
Primary intramedullary germinomas are very rare tumors in the spinal cord. This study presented a series of 11 patients with histologically proven primary intramedullary spinal germinomas. Their clinical and radiological findings, treatment records and long-term outcomes were reviewed. There were four male and seven female patients with a mean age of 27.1 years. Because germ cell tumors were suspected by frozen-section biopsy, gross total resection was unattempted. Partial resection was performed in four cases, while biopsy was performed in seven cases. Postoperatively, carboplatin and etoposide chemotherapy combined with low dose radiotherapy (30.6 Gy) to local spine was performed in seven cases, followed by radiotherapy alone (40 Gy) in four cases. All 11 patients had a complete response to either combination treatment or single radiotherapy, and the mass effect on the spinal cord vanished. The mean follow-up period was 75.4 months. At the last follow-up, the symptoms were improved in 10 cases and the current status of one patient was unchanged. The postoperative follow-up magnetic resonance imaging showed no recurrence or dissemination in any of the patients. Primary intramedullary germinomas are amenable to adjuvant radiochemotherapy and low dose radiation with etoposide and carboplatin chemotherapy is recommended. When combination therapy cannot be performed, relatively high doses of radiotherapy are advised, and radiation to the craniospinal axis may be unnecessary. A good clinical outcome after combination therapy or radiotherapy alone can be expected, and the risk of long-term recurrence and dissemination is low.
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References
Matsutani M, Sano K, Takakura K, Fujimaki T, Nakamura O, Funata N, Seto T (1997) Primary intracranial germ cell tumors: a clinical analysis of 153 histologically verified cases. J Neurosurg 86:446–455
Horowitz MB, Hall WA (1991) Central nervous system germinomas. a review. Arch Neurol 48:652–657
Dearnaley DP, A’Hern RP, Whittaker S, Bloom HJ (1990) Pineal and CNS germ cell tumors: Royal Marsden Hospital experience 1962–1987. Int J Radiat Oncol Biol Phys 18:773–781
Biswas A, Puri T, Goyal S, Gupta R, Eesa M, Julka PK, Rath GK (2009) Spinal intradural primary germ cell tumour-review of literature and case report. Acta Neurochir (Wien) 151:277–284
Matsuoka S, Itoh M, Shinonome T, Tanimura A (1991) Intramedullary spinal cord germinoma: case report. Surg Neurol 35:122–126
Kinoshita Y, Akatsuka K, Ohtake M, Kamitani H, Watanabe T (2010) Primary intramedullary spinal cord germinoma. Neurol Med Chir (Tokyo) 50:592–594
Zhu J, Gao Y, Zheng W, Yang J (2002) Intramedullary spinal cord germinoma: a case report. Chin Med J (Engl) 115:1418–1419
Madhukar M, Maller VG, Choudhary AK, Iantosca MR, Specht CS, Dias MS (2013) Primary intramedullary spinal cord germinoma. J Neurosurg Pediatr 11:605–609
Hata M, Ogino I, Sakata K, Murata H, Kawano N, Matsubara S (2002) Intramedullary spinal cord germinoma: case report and review of the literature. Radiology 223:379–383
McCormick PC, Torres R, Post KD, Stein BM (1990) Intramedullary ependymoma of the spinal cord. J Neurosurg 72:523–532
Aghakhani N, David P, Parker F, Lacroix C, Benoudiba F, Tadie M (2008) Intramedullary spinal ependymomas: analysis of a consecutive series of 82 adult cases with particular attention to patients with no preoperative neurological deficit. Neurosurgery 62:1279–1285
Slagel DD, Goeken JA, Platz CA, Moore SA (1995) Primary germinoma of the spinal cord: a case report with 28-year follow-up and review of the literature. Acta Neuropathol 90:657–659
Sasaki T, Amano T, Takao M, Shibata M, Shigematsu N, Fukuuchi Y (2002) A case of intramedullary spinal cord tumor producing human chorionic gonadotropin. J Neurooncol 56:247–250
Onodera S, Terae S, Kudo K, Tha K, Miyasaka K, Hida K, Iwasaki Y, Ota S (2006) Primary intramedullary spinal cord germinoma: case report and review of the literature. Eur J Radiol 57:41–45
Kawano K, Tsujimura T (1995) Intramedullary spinal cord germinoma. Arch Histopathol 2:52–54
Miyauchi A, Matsumoto K, Kohmura E, Doi T, Hashimoto K, Kawano K (1996) Primary intramedullary spinal cord germinoma. Case report. J Neurosurg 84:1060–1061
Chen F, Liu T, Li J, Li C (2009) The MRI manifestations of intramedullary germinoma of the spinal cord: a case report and review of the literature. J Nanjing Med Univ 23:212–216
Aoyama T, Hida K, Ishii N, Seki T, Ikeda J, Iwasaki Y (2007) Intramedullary spinal cord germinoma—2 case reports. Surg Neurol 67:177–183
Yamagata T, Takami T, Tsuyuguchi N, Goto T, Wakasa K, Ohata K (2009) Primary intramedullary spinal cord germinoma: diagnostic challenge and treatment strategy. Neurol Med Chir (Tokyo) 49:128–133
Acknowledgments
We would like to thank all the patients who trusted us and all the physicians and staff who helped this study.
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The authors report no conflict of interest concerning the materials or methods used in this study or the findings described in this paper. No benefits in any form have been or will be received from any commercial party related directly or indirectly to the subject of this manuscript.
Ethical standards
This retrospective study was approved by Institutional Review Board of Beijing Tiantan Hospital, Capital Medical University.
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Wu, L., Yang, T., Deng, X. et al. Treatment strategies and long-term outcomes for primary intramedullary spinal germinomas: an institutional experience. J Neurooncol 121, 541–548 (2015). https://doi.org/10.1007/s11060-014-1662-4
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DOI: https://doi.org/10.1007/s11060-014-1662-4