Surgical Role in Management of Intracranial Germ Cell Tumors in Pediatric Age Group

Mohamed Reda; Mohamed Elbeltagy; Mohamed Kamal; Mahmoud Hammad

doi:doi:10.11648/j.crj.20190702.16

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Surgical Role in Management of Intracranial Germ Cell Tumors in Pediatric Age Group

Mohamed Reda, Mohamed Elbeltagy, Mohamed Kamal, Mahmoud Hammad

Published in Cancer Research Journal (Volume 7, Issue 2)

Received: 14 May 2019 Accepted: 12 June 2019 Published: 24 June 2019

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Abstract

Introduction: Primary intracranial germ cell tumors (ICGCTs) are rare, histologically diverse, and diagnostically challenging tumors that are usually localized in the pineal and suprasellar regions of the brain. Advanced neurosurgical techniques such as neuroendoscopy and frameless stereotactic biopsy have made diagnosis of newly discovered cases of ICGCTs easier and safer. Material and methods: Seventeen patients with intracranial germ cell tumors operated upon between 2008 to 2012 at the Children's Cancer Hospital Egypt, were retrospectively reviewed and analyzed regarding the surgical decision, clinical outcome and surgical complications. Results: There were 9 cases of germinoma (53%), and 8 cases of non-germinomatous germ cell tumors (47%). Nine cases were in the pineal region, six in the suprasellar, and two in the thalamic region. Ten cases were operated upon initially by open surgery and frozen section with subtotal resection and seven cases were biopsied either endoscopically (3 cases) or by frameless guided stereotaxic (4 cases). Accurate pathology was achieved in all biopsied cases without major complications. In the germinoma group, the 4-year overall survival and progression free survival rate were 75% for both at a median follow up period of 26 (range 1 -50) months. For the non-germinomatous germ cell tumors group, the 4-year OS and PFS rates were 36.5% and 31.2% at a median follow up period of 11 (range 2-54) months, respectively. Conclusion: In cases of intracranial germ cell tumors with negative tumor markers the role of surgery is important in the establishment of proper histopathological diagnosis. However, in Non Germinomatous Germ Cell Tumors, further investigations should be done regarding the extent of resection owing to the poor long-term outcome.

Published in	Cancer Research Journal (Volume 7, Issue 2)
DOI	10.11648/j.crj.20190702.16
Page(s)	66-72
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2019. Published by Science Publishing Group

Keywords

Intracranial Germ Cell Tumors, Pediatric, Endoscopic Biopsy, Stereotactic Biopsy

References

[1]	Villano JL, Virk IY, Ramirez V, Propp JM, Engelhard HH, McCarthy BJ. Descriptive epidemiology of central nervous system germ cell tumors: nonpineal analysis. Neuro Oncol, 2010 12: 257–264.
[2]	Dolecek TA, Propp JM, Stroup NE, Kruchko C. CBTRUS Statistical Report: Primary Brain and Central Nervous System Tumors Diagnosed in the United States in 2005-2009. Neuro Oncol, 2012 14: v1–v49.
[3]	Matsutani M, Japanese Pediatric Brain Tumor Study Group. Combined chemotherapy and radiation therapy for CNS germ cell tumors--the Japanese experience. J Neurooncol, 2001 54: 311–6.
[4]	Echevarria ME, Fangusaro J, Goldman S. Pediatric Central Nervous System Germ Cell Tumors: A Review. Oncologist, 2008 13: 690–699.
[5]	Fetcko K, Dey M. Primary Central Nervous System Germ Cell Tumors: A Review and Update HHS Public Access. Med Res Arch, 2018
[6]	Matsutani M, Sano K, Takakura K, Fujimaki T, Nakamura O, Funata N, Seto T. Primary intracranial germ cell tumors: a clinical analysis of 153 histologically verified cases. J Neurosurg, 1997 86: 446–455.
[7]	Souweidane MM, Krieger MD, Weiner HL, Finlay JL. Surgical management of primary central nervous system germ cell tumors. J Neurosurg Pediatr, 2010 6: 125–130.
[8]	Linstadt D, Wara WM, Edwards MSB, Hudgins RJ, Sheline GE. Radiotherapy of primary intracranial germinomas: The case against routine craniospinal irradiation. Int J Radiat Oncol Biol Phys, 1988 15: 291–297.
[9]	Shirato H, Nishio M, Sawamura Y, Myohjin M, Kitahara T, Nishioka T, Mizutani Y, Abe H, Miyasaka K. Analysis of long-term treatment of intracranial germinoma. Int J Radiat Oncol Biol Phys, 1997 37: 511–515.
[10]	Calaminus G, Kortmann R, Worch J, Nicholson JC, Alapetite C, Garrè ML, Patte C, Ricardi U, Saran F, Frappaz D. SIOP CNS GCT 96: Final report of outcome of a prospective, multinational nonrandomized trial for children and adults with intracranial germinoma, comparing craniospinal irradiation alone with chemotherapy followed by focal primary site irradiation for patients with localized disease. Neuro Oncol, 2013 15: 788–796.
[11]	Kellie SJ, Boyce H, Dunkel IJ, Diez B, Rosenblum M, Brualdi L, Finlay JL. Intensive cisplatin and cyclophosphamide-based chemotherapy without radiotherapy for intracranial germinomas: Failure of a primary chemotherapy approach. Pediatr Blood Cancer, 2004 43: 126–133.
[12]	Kanamori M, Kumabe T, Saito R, Yamashita Y, Sonoda Y, Ariga H, Takai Y, Tominaga T. Optimal treatment strategy for intracranial germ cell tumors: a single institution analysis. J Neurosurg Pediatr, 2009 4: 506–514.
[13]	Weiner HL, Lichtenbaum RA, Wisoff JH, Snow RB, Souweidane MM, Bruce JN, Finlay JL. Delayed surgical resection of central nervous system germ cell tumors. Neurosurgery, 2002 50: 727-33; discussion 733–4.
[14]	Hoffman HJ, Otsubo H, Hendrick EB, Humphreys RP, Drake JM, Becker LE, Greenberg M, Jenkin D. Intracranial germ-cell tumors in children. J Neurosurg, 1991 74: 545–551.
[15]	Bouffet E, Baranzelli MC, Patte C, Portas M, Edan C, Chastagner P, et al: Combined treatment modality for intracranial germinomas: results of a multicentre SFOP experience. Société Française d’Oncologie Pédiatrique. Br J Cancer 79:1199–204, 1999.
[16]	Jennings MT, Gelman R, Hochberg F: Intracranial germ-cell tumors: natural history and pathogenesis. J Neurosurg 63: 155–167, 1985
[17]	Noudel R, Vinchon M, Dhellemmes P, Litré CF, Rousseaux P. Intracranial teratomas in children: the role and timing of surgical removal. J Neurosurg Pediatr, 2008 2: 331–338.
[18]	Packer RJ, Cohen BH, Cooney K. Intracranial germ cell tumors. The Oncologist 2000; 5: 312–320.
[19]	Al-Tamimi YZ, Bhargava D, Surash S, Ramirez RE, Novegno F, Crimmins DW, Tyagi AK, Chumas PD. Endoscopic biopsy during third ventriculostomy in paediatric pineal region tumours. Child’s Nerv Syst, 2008 24: 1323–1326.
[20]	Chibbaro S, Rocco F Di, Makiese O, Reiss A, Poczos P, Mirone G, Servadei F, George B, Crafa P, Polivka M, Romano A. Neuroendoscopic management of posterior third ventricle and pineal region tumors: Technique, limitation, and possible complication avoidance. Neurosurg Rev, 2012 35: 331–338.
[21]	Morgenstern PF, Osbun N, Schwartz TH, Greenfield JP, Tsiouris AJ, Souweidane MM. Pineal region tumors: an optimal approach for simultaneous endoscopic third ventriculostomy and biopsy. Neurosurg Focus, 2011 30: E3.
[22]	O’Callaghan AM, Katapodis O, Ellison DW et al. The growing teratoma syndrome in a nongerminomatous germ cell tumor of the pineal gland: A case report and review. Cancer 1997; 80: 942–947.
[23]	Jooma R, Kendall BE. Diagnosis and management of pineal tumors. J Neurosurg 1983; 58: 654–665.
[24]	Ray P, Jallo GI, Kim RY et al. Endoscopic third ventriculostomy for tumor related hydrocephalus in a pediatric population. Neurosurg Focus 2005; 19: E8.
[25]	O’Brien DF, Hayhurst C, Pizer B, Mallucci CL. Outcomes in patients undergoing single-trajectory endoscopic third ventriculostomy and endoscopic biopsy for midline tumors presenting with obstructive hydrocephalus. J Neurosurg Pediatr, 2008 105: 219–226.
[26]	Wong T-T, Chen H-H, Liang M-L, Yen Y-S, Chang F-C. Neuroendoscopy in the management of pineal tumors. Child’s Nerv Syst, 2011 27: 949–959.
[27]	Grossman R, Sadetzki S, Spiegelmann R, Ram Z. Haemorrhagic complications and the incidence of asymptomatic bleeding associated with stereotactic brain biopsies. Acta Neurochir (Wien), 2005 147: 627–631.
[28]	Lefranc M, Touzet G, Caron S, Maurage CA, Assaker R, Blond S. Are stereotactic sample biopsies still of value in the modern management of pineal region tumours? Lessons from a single-department, retrospective series. Acta Neurochir (Wien), 2011 153: 1111–1121.
[29]	Malone H, Yang J, Hershman DL, Wright JD, Bruce JN, Neugut AI. Complications Following Stereotactic Needle Biopsy of Intracranial Tumors. World Neurosurg, 2015 84: 1084–1089.
[30]	Bamberg M, Kortmann R-D, Calaminus G, Becker G, Meisner C, Harms D, Göbel U. Radiation Therapy for Intracranial Germinoma: Results of the German Cooperative Prospective Trials MAKEI 83/86/89. J Clin Oncol, 1999 17: 2585–2585.
[31]	Sawamura Y, Ikeda J, Shirato H et al. Germ cell tumours of the central nervous system: Treatment consideration based on 111 cases and their long-term clinical outcomes. Eur J Cancer 1998; 34: 104–110.
[32]	Robertson PL, DaRosso RC, Allen JC. Improved prognosis of intracranial non-germinoma germ cell tumors with multimodality therapy. J Neurooncol 1997; 32: 71– 80.
[33]	Calaminus G, Bamberg M, Jo¨rgens H et al. Impact of surgery, chemotherapy and irradiation on long term outcome of intracranial malignant nongerminomatous germ cell tumors: Results of the German Cooperative Trial MAKEI 89. Klin Padiatr 2004; 216: 141–149.
[34]	Calaminus G, Bamberg M, Harms D et al. AFP/beta–HCG secreting CNS germ cell tumors: Long-term outcome with respect to initial symptoms and primary tumor resection. Results of the cooperative trial MAKEI 89. Neuropediatrics 2005; 36: 71–77.

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APA Style

Mohamed Reda, Mohamed Elbeltagy, Mohamed Kamal, Mahmoud Hammad. (2019). Surgical Role in Management of Intracranial Germ Cell Tumors in Pediatric Age Group. Cancer Research Journal, 7(2), 66-72. https://doi.org/10.11648/j.crj.20190702.16

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ACS Style

Mohamed Reda; Mohamed Elbeltagy; Mohamed Kamal; Mahmoud Hammad. Surgical Role in Management of Intracranial Germ Cell Tumors in Pediatric Age Group. Cancer Res. J. 2019, 7(2), 66-72. doi: 10.11648/j.crj.20190702.16

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AMA Style

Mohamed Reda, Mohamed Elbeltagy, Mohamed Kamal, Mahmoud Hammad. Surgical Role in Management of Intracranial Germ Cell Tumors in Pediatric Age Group. Cancer Res J. 2019;7(2):66-72. doi: 10.11648/j.crj.20190702.16

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@article{10.11648/j.crj.20190702.16,
  author = {Mohamed Reda and Mohamed Elbeltagy and Mohamed Kamal and Mahmoud Hammad},
  title = {Surgical Role in Management of Intracranial Germ Cell Tumors in Pediatric Age Group},
  journal = {Cancer Research Journal},
  volume = {7},
  number = {2},
  pages = {66-72},
  doi = {10.11648/j.crj.20190702.16},
  url = {https://doi.org/10.11648/j.crj.20190702.16},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.crj.20190702.16},
  abstract = {Introduction: Primary intracranial germ cell tumors (ICGCTs) are rare, histologically diverse, and diagnostically challenging tumors that are usually localized in the pineal and suprasellar regions of the brain. Advanced neurosurgical techniques such as neuroendoscopy and frameless stereotactic biopsy have made diagnosis of newly discovered cases of ICGCTs easier and safer. Material and methods: Seventeen patients with intracranial germ cell tumors operated upon between 2008 to 2012 at the Children's Cancer Hospital Egypt, were retrospectively reviewed and analyzed regarding the surgical decision, clinical outcome and surgical complications. Results: There were 9 cases of germinoma (53%), and 8 cases of non-germinomatous germ cell tumors (47%). Nine cases were in the pineal region, six in the suprasellar, and two in the thalamic region. Ten cases were operated upon initially by open surgery and frozen section with subtotal resection and seven cases were biopsied either endoscopically (3 cases) or by frameless guided stereotaxic (4 cases). Accurate pathology was achieved in all biopsied cases without major complications. In the germinoma group, the 4-year overall survival and progression free survival rate were 75% for both at a median follow up period of 26 (range 1 -50) months. For the non-germinomatous germ cell tumors group, the 4-year OS and PFS rates were 36.5% and 31.2% at a median follow up period of 11 (range 2-54) months, respectively. Conclusion: In cases of intracranial germ cell tumors with negative tumor markers the role of surgery is important in the establishment of proper histopathological diagnosis. However, in Non Germinomatous Germ Cell Tumors, further investigations should be done regarding the extent of resection owing to the poor long-term outcome.},
 year = {2019}
}

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TY  - JOUR
T1  - Surgical Role in Management of Intracranial Germ Cell Tumors in Pediatric Age Group
AU  - Mohamed Reda
AU  - Mohamed Elbeltagy
AU  - Mohamed Kamal
AU  - Mahmoud Hammad
Y1  - 2019/06/24
PY  - 2019
N1  - https://doi.org/10.11648/j.crj.20190702.16
DO  - 10.11648/j.crj.20190702.16
T2  - Cancer Research Journal
JF  - Cancer Research Journal
JO  - Cancer Research Journal
SP  - 66
EP  - 72
PB  - Science Publishing Group
SN  - 2330-8214
UR  - https://doi.org/10.11648/j.crj.20190702.16
AB  - Introduction: Primary intracranial germ cell tumors (ICGCTs) are rare, histologically diverse, and diagnostically challenging tumors that are usually localized in the pineal and suprasellar regions of the brain. Advanced neurosurgical techniques such as neuroendoscopy and frameless stereotactic biopsy have made diagnosis of newly discovered cases of ICGCTs easier and safer. Material and methods: Seventeen patients with intracranial germ cell tumors operated upon between 2008 to 2012 at the Children's Cancer Hospital Egypt, were retrospectively reviewed and analyzed regarding the surgical decision, clinical outcome and surgical complications. Results: There were 9 cases of germinoma (53%), and 8 cases of non-germinomatous germ cell tumors (47%). Nine cases were in the pineal region, six in the suprasellar, and two in the thalamic region. Ten cases were operated upon initially by open surgery and frozen section with subtotal resection and seven cases were biopsied either endoscopically (3 cases) or by frameless guided stereotaxic (4 cases). Accurate pathology was achieved in all biopsied cases without major complications. In the germinoma group, the 4-year overall survival and progression free survival rate were 75% for both at a median follow up period of 26 (range 1 -50) months. For the non-germinomatous germ cell tumors group, the 4-year OS and PFS rates were 36.5% and 31.2% at a median follow up period of 11 (range 2-54) months, respectively. Conclusion: In cases of intracranial germ cell tumors with negative tumor markers the role of surgery is important in the establishment of proper histopathological diagnosis. However, in Non Germinomatous Germ Cell Tumors, further investigations should be done regarding the extent of resection owing to the poor long-term outcome.
VL  - 7
IS  - 2
ER  -

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Author Information

Mohamed Reda

Department of Neurosurgery, Kasralainy Medical School, Cairo University and Children's Cancer Hospital Egypt, Cairo, Egypt
Mohamed Elbeltagy

Department of Neurosurgery, Kasralainy Medical School, Cairo University and Children's Cancer Hospital Egypt, Cairo, Egypt
Mohamed Kamal

Department of Research Children's Cancer Hospital Egypt, Cairo, Egypt
Mahmoud Hammad

Department of Pediatric Oncology, National Cancer Institute, Cairo University and Children's Cancer Hospital Egypt, Cairo, Egypt

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Mohamed Reda, Mohamed Elbeltagy, Mohamed Kamal, Mahmoud Hammad. (2019). Surgical Role in Management of Intracranial Germ Cell Tumors in Pediatric Age Group. Cancer Research Journal, 7(2), 66-72. https://doi.org/10.11648/j.crj.20190702.16

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ACS Style

Mohamed Reda; Mohamed Elbeltagy; Mohamed Kamal; Mahmoud Hammad. Surgical Role in Management of Intracranial Germ Cell Tumors in Pediatric Age Group. Cancer Res. J. 2019, 7(2), 66-72. doi: 10.11648/j.crj.20190702.16

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AMA Style

Mohamed Reda, Mohamed Elbeltagy, Mohamed Kamal, Mahmoud Hammad. Surgical Role in Management of Intracranial Germ Cell Tumors in Pediatric Age Group. Cancer Res J. 2019;7(2):66-72. doi: 10.11648/j.crj.20190702.16

Copy | Download

@article{10.11648/j.crj.20190702.16,
  author = {Mohamed Reda and Mohamed Elbeltagy and Mohamed Kamal and Mahmoud Hammad},
  title = {Surgical Role in Management of Intracranial Germ Cell Tumors in Pediatric Age Group},
  journal = {Cancer Research Journal},
  volume = {7},
  number = {2},
  pages = {66-72},
  doi = {10.11648/j.crj.20190702.16},
  url = {https://doi.org/10.11648/j.crj.20190702.16},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.crj.20190702.16},
  abstract = {Introduction: Primary intracranial germ cell tumors (ICGCTs) are rare, histologically diverse, and diagnostically challenging tumors that are usually localized in the pineal and suprasellar regions of the brain. Advanced neurosurgical techniques such as neuroendoscopy and frameless stereotactic biopsy have made diagnosis of newly discovered cases of ICGCTs easier and safer. Material and methods: Seventeen patients with intracranial germ cell tumors operated upon between 2008 to 2012 at the Children's Cancer Hospital Egypt, were retrospectively reviewed and analyzed regarding the surgical decision, clinical outcome and surgical complications. Results: There were 9 cases of germinoma (53%), and 8 cases of non-germinomatous germ cell tumors (47%). Nine cases were in the pineal region, six in the suprasellar, and two in the thalamic region. Ten cases were operated upon initially by open surgery and frozen section with subtotal resection and seven cases were biopsied either endoscopically (3 cases) or by frameless guided stereotaxic (4 cases). Accurate pathology was achieved in all biopsied cases without major complications. In the germinoma group, the 4-year overall survival and progression free survival rate were 75% for both at a median follow up period of 26 (range 1 -50) months. For the non-germinomatous germ cell tumors group, the 4-year OS and PFS rates were 36.5% and 31.2% at a median follow up period of 11 (range 2-54) months, respectively. Conclusion: In cases of intracranial germ cell tumors with negative tumor markers the role of surgery is important in the establishment of proper histopathological diagnosis. However, in Non Germinomatous Germ Cell Tumors, further investigations should be done regarding the extent of resection owing to the poor long-term outcome.},
 year = {2019}
}

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TY  - JOUR
T1  - Surgical Role in Management of Intracranial Germ Cell Tumors in Pediatric Age Group
AU  - Mohamed Reda
AU  - Mohamed Elbeltagy
AU  - Mohamed Kamal
AU  - Mahmoud Hammad
Y1  - 2019/06/24
PY  - 2019
N1  - https://doi.org/10.11648/j.crj.20190702.16
DO  - 10.11648/j.crj.20190702.16
T2  - Cancer Research Journal
JF  - Cancer Research Journal
JO  - Cancer Research Journal
SP  - 66
EP  - 72
PB  - Science Publishing Group
SN  - 2330-8214
UR  - https://doi.org/10.11648/j.crj.20190702.16
AB  - Introduction: Primary intracranial germ cell tumors (ICGCTs) are rare, histologically diverse, and diagnostically challenging tumors that are usually localized in the pineal and suprasellar regions of the brain. Advanced neurosurgical techniques such as neuroendoscopy and frameless stereotactic biopsy have made diagnosis of newly discovered cases of ICGCTs easier and safer. Material and methods: Seventeen patients with intracranial germ cell tumors operated upon between 2008 to 2012 at the Children's Cancer Hospital Egypt, were retrospectively reviewed and analyzed regarding the surgical decision, clinical outcome and surgical complications. Results: There were 9 cases of germinoma (53%), and 8 cases of non-germinomatous germ cell tumors (47%). Nine cases were in the pineal region, six in the suprasellar, and two in the thalamic region. Ten cases were operated upon initially by open surgery and frozen section with subtotal resection and seven cases were biopsied either endoscopically (3 cases) or by frameless guided stereotaxic (4 cases). Accurate pathology was achieved in all biopsied cases without major complications. In the germinoma group, the 4-year overall survival and progression free survival rate were 75% for both at a median follow up period of 26 (range 1 -50) months. For the non-germinomatous germ cell tumors group, the 4-year OS and PFS rates were 36.5% and 31.2% at a median follow up period of 11 (range 2-54) months, respectively. Conclusion: In cases of intracranial germ cell tumors with negative tumor markers the role of surgery is important in the establishment of proper histopathological diagnosis. However, in Non Germinomatous Germ Cell Tumors, further investigations should be done regarding the extent of resection owing to the poor long-term outcome.
VL  - 7
IS  - 2
ER  -

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