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Loco-regional extensions of central nervous system germ cell tumors: a retrospective radiological analysis of 100 patients

  • Diagnostic Neuroradiology
  • Published:
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Abstract

Purpose

The current staging system of central nervous system (CNS) germ cell tumors (GCT) includes a binary classification in “localized” or “metastatic” disease based on the absence or presence of leptomeningeal dissemination. Loco-regional tumor dissemination has been barely described whereas its accurate definition might be useful in terms of prognosis and treatment, especially for radiation therapy planning. Our purpose was therefore to describe MR patterns and prevalence of loco-regional extensions of these tumors.

Methods

One hundred consecutive patients (median age 16.3 years, range 7–41 years, sex ratio 7:1) with a histologically or biologically proven CNS GCT were retrospectively included. Brain and spinal MRI at diagnosis were reviewed by two neuroradiologists focusing on MR patterns of primaries and loco-regional extensions. When available, follow-up MR exams were analyzed.

Results

Pure germinoma represented 84/100 cases. Primaries were unifocal pineal (n = 49/100), bifocal pineal and supra-sellar (n = 27/100), isolated supra-sellar (n = 21/100), isolated basal ganglia (n = 2/100) or trifocal pineal, supra-sellar, and basal ganglia (n = 1/100). Metastatic disease occurred in 6/100 patients (depicted by MRI in two and CSF cytology in four). Loco-regional extensions were observed in all patients and classified as follows: third ventricle (n = 88/100), thalamus (n = 47/100), midbrain (n = 42/100), distant sub-ependymal areas (n = 19/100), optic pathways (n = 19/100), lateral ventricles (n = 7/100), cavernous sinus (n = 6/100), corpus callosum (n = 4/100), and fourth ventricle (n = 3/100).

Conclusion

CNS GCT present with specific loco-regional extensions at diagnosis. Improving their recognition will be helpful to further understand their prognostic value and potentially to optimize the treatment.

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Acknowledgements

Mathilde Donnat provided valuable help to collect all clinical and follow-up data.

Funding

No funding was received for this study.

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Authors and Affiliations

  1. Imaging Department, Institut Curie, 26 rue d’Ulm, 75005, Paris, France

    Loïc Duron, Flavie Sadones, Philippe Thiesse, Cécile Cellier, Claire Alapetite & Hervé J. Brisse

  2. Department of Pediatric, Adolescents and Young adults Oncology, Institut Curie, 26 rue d’Ulm, 75005, Paris, France

    François Doz

  3. University Paris Descartes, 12 rue de l’Ecole de Médecine, 75006, Paris, France

    François Doz

  4. Department of Adult and Pediatric Neuro-Oncology, Centre Léon Bérard, 69373, Lyon Cedex 08, France

    Didier Frappaz

  5. Paris Sciences et Lettres Research University, Paris, France

    Hervé J. Brisse

Authors
  1. Loïc Duron
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  2. Flavie Sadones
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  3. Philippe Thiesse
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  4. Cécile Cellier
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Correspondence to Loïc Duron.

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The authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

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Duron, L., Sadones, F., Thiesse, P. et al. Loco-regional extensions of central nervous system germ cell tumors: a retrospective radiological analysis of 100 patients. Neuroradiology 60, 27–34 (2018). https://doi.org/10.1007/s00234-017-1928-6

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  • DOI: https://doi.org/10.1007/s00234-017-1928-6

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