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Germ cell tumor in the hypothalamo-neurohypophysial region: clinical features and treatment

  • Neurooncology
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Abstract

Twenty-one patients with germ cell tumors (17 germinomas and 4 teratomas) involving the hypothalamic-neurohypophysial (HN) region were reviewed retrospectively. Eleven patients were males and 10 females, and their ages ranged from 7 to 45 years (average 18.5 years). Diabetes insipidus was the initial and the most prominent symptom in most germinomas; in teratomas the most prominent symptom was visual disturbance. Fifteen patients with germinomas were treated by radiotherapy, and 4 with teratomas were treated by surgical resection alone. Two recent germinoma patients with extensive CSF dissemination were treated with systemic chemotherapy consisting of anticancer platinum drugs and etoposide, which resulted in a complete disappearance of the tumors. Patients with germinoma treated after the introduction of CT scanning had a greatly improved mortality rate, and their actual survival rate was 87.5% over 10 years. On the basis of this review, the authors consider that diagnosis at an early stage of the disease and chemotherapy, which can be an effective therapeuric alternative to radiation therapy, may improve not only the mortality rate but also the quality of life of patients with HN germ cell tumors.

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References

  1. Abay EO II, ER Laws Jr, G Grado, JE Bruckman, GS Forbes, MR Gomez, M Scott: Pineal tumors in children and adolescents. Treatment by CSF shunting and radiotherapy. J Neurosurg 55 (1981) 889–895

    Google Scholar 

  2. Aida T, H Abe, M Tsuru: Treatment and prognosis of primary intracranial germ cell tumors. With special reference to local recurrence and spinal metastasis. Neurol Med Chir (Tokyo) 23 (1983) 447–455

    Google Scholar 

  3. Allen JC: Management of primary intracranial germ cell tumors of childhood. Pediatr Neurosci 13 (1987) 152–157

    Google Scholar 

  4. Allen JC, JH Kim, RJ Packer: Neoadjuvant chemotherapy for newly diagnosed germ-cell tumors of the central nervous system. J Neurosurg 67 (1987) 65–70

    Google Scholar 

  5. Arita N, S Bitoh, Y Ushio, T Hayakawa, H Hasegawa, M Fujiwara, K Ozaki, L Par-Khen, T Mori. Primary pineal endodermal sinus tumor with elevated serum and CSF alphafetoprotein levels. J Neurosurg 53 (1980) 244–248

    Google Scholar 

  6. Asai A, M Matsutani, T Kohno, O Nakamura, H Tanaka, T Fujimaki, N Funada, T Matsuda, K Nagata, K Takakura: Subacute brain atrophy after radiation therapy for malignant tumors. Cancer 63 (1989) 1962–1974

    Google Scholar 

  7. Baskin DS, CB Wilson: Transsphenoidal surgery of intrasellar germinomas. Report of two cases. J Neurosurg 59 (1983) 1063–1066

    Google Scholar 

  8. De Tribolet N, L Barrelet: Successful chemotherapy of pinealoma (letter). Lancet 2 (1977) 1228–1229

    Google Scholar 

  9. Einhorn LH, SD Williams, M Troner, R Birch, FA Greco: The role of maintenance therapy in disseminated testicular cancer. N Engl J Med 305 (1981) 727–731

    Google Scholar 

  10. Fujisawa I, R Asato, R Okumura, Y Nakano, T Shibata, D Hamanaka, T Hashimoto, J Konishi: Magnetic reesonance imaging of neurohypophyseal germinomas. Cancer 68 (1991) 1009–1014

    Google Scholar 

  11. Gay JC, RL Janco, JN Lukens: Systemic metastases in primary intracranial germinoma. Case report and literature review. Cancer 55 (1985) 2688–2690

    Google Scholar 

  12. Ginsberg S, J Krishner, S Reich, L Panasci, T Finkelstein, S Fandrich, A Fitzpatrick, L Shechtman, R Comis: Systemic chemotherapy for a primary germ cell tumor of the brain: a pharmacokinetic study. Cancer Treat Rep 65 (1981) 477–483

    Google Scholar 

  13. Handa H, J Yamashita: [Current treatment of pineal tumors]. Neurol Med Chir (Tokyo) 21 (1981) 147–154 (Jpn)

    Google Scholar 

  14. Hida K, T Aida, H Abe: [Recurrent germinoma successfully treated with cisplatin]. Neurol Med Chir (Tokyo) 29 (1989) 510–514 (Jpn)

    Google Scholar 

  15. Hoffman HJ, H Otsubo, EB Hendrick, RP Humphreys, JM Drake, LE Becker, M Greenberg, D. Jenkin: Intracranial germ-cell tumors in children. J Neurosurg 74 (1991) 545–551

    Google Scholar 

  16. Howman-Giles R, M Besser, IH Johnston, MD Silva: Disseminated hematogeneous metastases from a pineal germinoma in an infant. Case report. J Neurosurg 60 (1984) 835–837

    Google Scholar 

  17. Itoyama Y, M Kochi, H Yamamoto, J Kuratsu, S Uemura, Y Ushio: Clinical study of intracranial nongerminomatous germ cell tumors producing α-fetoprotein. Neurosurgery 27 (1990) 454–460

    Google Scholar 

  18. Jenkin RDT, WJK Simpson, CWJ Keen: Pineal and suprasellar germinomas. Results of radiation treatment. J Neurosurg 48 (1978) 99–107

    Google Scholar 

  19. Jennings MT, R Gelman, F Hochberg: Intracranial germ-cell tumors: natural history and pathogenesis. J Neurosurg 63 (1985) 155–167

    Google Scholar 

  20. Kasper CS, NR Schneider, JH Childers, JD Wilson: Suprasellar germinoma. Unresolved problems in diagnosis, pathogenesis, and management. Am J Med 75 (1983) 705–711

    Google Scholar 

  21. Kobayashi T, J Yoshida, J Ishiyama, S Noda, A Kita, Y Kida: Combination chemotherapy with cisplatin and etoposide for malignant intracranial germ-cell tumors. An experimental and clinical study. J Neurosurg 70 (1989) 676–681

    Google Scholar 

  22. Kobayashi T, J Yoshida, S Noda, Y Kida, M Teraoka, H Itoh: [Combination chemotherapy with CDDP and Etoposide (P-E therapy) for intracranial germ-cell tumors]. Shoni no Noshinkei 15 (1990) 409–416 (Jpn)

    Google Scholar 

  23. Kramer ED, S Rafto, RJ Packer, RA Zimmerman: Comparison of myelography with CT follow-up versus gadolinium MRI for subarachnoid metastatic disease in children. Neurology 41 (1991) 46–50

    Google Scholar 

  24. Matsukado Y, H Abe, R Tanaka, T Kobayashi, J Yamashita, A Nishimoto, Y Ushio, K Satou, M Matsutani, K Takakura, K Sano: [Cisplatin, vinblastine, and bleomycin (PVB) combination chemotherapy in the treatment of intracranial malignant germ cell tumors — a preliminary report of phase II study — The Japanese Intracranial Germ Cell Study Group]. Gan No Rinsho 32 (1986) 1387–1393 (Jpn)

    Google Scholar 

  25. Matsutani M, K Takakura, K Sano: Primary intracranial germ cell tumors: Pathology and treatment. Prog exp Tumor Res 30 (1987) 307–312

    Google Scholar 

  26. Matsutani M, K Takakura, K Sano: [Longterm follow-up of patients with primary intracranial germinomas]. Neurosurgeons 9 (1990) 134–140 (Jpn)

    Google Scholar 

  27. Nagasawa S, H Kikuchi, J Yamashita, K Mitsuno: Intracranial and spinal germinomas occurring four years after spinal cord germinoma. Case report. Neurol Med Chir (Tokyo) 31 (1991) 729–731

    Google Scholar 

  28. Neuwelt EA, EP Frenkel, RG Smith: Suprasellar germinomas (ectopic pinealomas): Aspects of immunological characterization and successful chemotherapeutic responses in recurrent disease. Neurosurgery 7 (1980) 352–358

    Google Scholar 

  29. Okuno S, J Ishikawa, K Nozaki, K Yamamoto: Recurrent intracranial germinoma refractory to conventional irradiation: Effective chemotherapy consisting of cisplatin and etoposide. Case report. Neurol Med Chir (Tokyo) 32 (1992) 351–355

    Google Scholar 

  30. Packer RJ, LN Sutton, TE Atkins, J Radcliffe, GR Bunin, G D'Angio, KR Siegel, L Schut: A prospective study of cognitive function in children receiving whole-brain radiotherapy and chemotherapy: 2-year results. J Neurosurg 70 (1989) 707–713

    Google Scholar 

  31. Page RB, PV Plourde, D Goldwell, JJ Heald, J Weinstein: Intrasellar mixed germ-cell tumor. Case report. J Neurosurg 58 (1983) 766–770

    Google Scholar 

  32. Saitoh M, N Tamaki, T Kokunai, S Matsumoto: Clinico-biological behavior of germ-cell tumors. Child's Nerv Syst 7 (1991) 246–250

    Google Scholar 

  33. Sano K, M Matsutani: Pinealoma (Germinoma) treated by direct surgery and postoperative irradiation. A long-term follow-up. Child's Brain 8 (1981) 81–97

    Google Scholar 

  34. Shen DY, AT Guay, ML Silverman, RL Hybels, SR Freidberg: Primary intrasellar germinoma in a woman presenting with secondary amenorrhea and hyperprolactinemia. Neurology 15 (1984) 417–420

    Google Scholar 

  35. Shokry A, RC Janzer, Von AR Hochstetter, MG Yasargil, C Hedinger: Primary intracranial germ-cell tumors. A clinicopathological study of 14 cases. J Neurosurg 62 (1983) 826–830

    Google Scholar 

  36. Siegal T, MR Pfeffer, R Catane, A Sulkes, MJ Gomori, Z Fuks: Successful chemotherapy of recurrent intracranial germinoma with spinal metastases. Neurology 33 (1983) 631–633

    Google Scholar 

  37. Stoter G, CPJ Vendrik, A Struyvenberg, DT Sleyfer, R Vriesendorp, HS Koops, van AT Oosterom, WWTB Huinink, AHM Pinedo: Five-year survival of patients with disseminated nonseminomatous testicular cancer treated with cisplatin, vinblastine, and bleomycin. Cancer 54 (1984) 1521–1524

    Google Scholar 

  38. Sung DI, L Harisiadis, CH Chang: Midline pineal tumors and suprasellar germinomas: Highly curable by irradiation. Radiology 128 (1978) 745–751

    Google Scholar 

  39. Takei Y, GS Pearl: Ultrastructural study of intracranial yolk sac tumor: With special reference to the oncologic phylogeny of germ cell tumors. Cancer 48 (1981) 2038–2046

    Google Scholar 

  40. Takeuchi J, K Mori, F Tani, S Waga, H Handa: Teratomas in the suprasellar region: Report of five cases. Surg Neurol 3 (1975) 247–255

    Google Scholar 

  41. Tokoro K, Y Chiba, S Murase, S Yagishita, Y Kyuma: Subarachnoid dissemination of pineal germinoma 9 years after radiation therapy without a local relapse. Neurol Med Chir (Tokyo) 31 (1991) 725–728

    Google Scholar 

  42. Waga S, H Handa, J Yamashita: Intracranial germinomas: Treatment and results. Surg Neurol 11 (1979) 167–172

    Google Scholar 

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Authors and Affiliations

  1. Department of Neurosurgery, Neurological Institute, Faculty of Medicine, Kyushu University, Japan

    Shunji Nishio, Takanori Inamura, Iwao Takeshita & Masashi Fukui

  2. Department of Neurosurgery, Kaizuka Hospital, Japan

    Kazufumi Kamikaseda

Authors
  1. Shunji Nishio
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  2. Takanori Inamura
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  3. Iwao Takeshita
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  4. Masashi Fukui
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  5. Kazufumi Kamikaseda
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Nishio, S., Inamura, T., Takeshita, I. et al. Germ cell tumor in the hypothalamo-neurohypophysial region: clinical features and treatment. Neurosurg. Rev. 16, 221–227 (1993). https://doi.org/10.1007/BF00304332

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  • DOI: https://doi.org/10.1007/BF00304332

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