Germinoma classification
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Simrat Sarai, M.D. [2]
Overview
Germinoma may be classified according to World Health Organization into two groups: germinomas and nongerminomatous germ cell tumors. Based on the tumor markers secreted into the cerebrospinal fluid (CSF) and serum, as well as by the presence of histochemical markers on tumor cells, intracranial germ cell tumors may be classified into either secreting or non secreting tumors. Based on the prognosis of the tumor, intracranial germ cell tumors may be classified into either good, intermediate, or poor prognosis.[1][2][3]
Classification
- Based on the histology, germinoma may be classified according to World Health Organization into two groups:[1][2][3]
- Germinomas
- Nongerminomatous germ cell tumors
- Tumors that consists of more than one of the above histological types are termed mixed GCTs
- Pure germinomas account for 65% of all CNS germ cell tumors GCTs
- Germinomas with mature and/or immature teratoma account for 15% of all CNS germ cell tumors
- Mixed germinomas and nongerminomatous germ cell tumors NGGCTs represent approximately 20% of CNS germ cell tumors.[4]
- Classification of germinoma according to World Health Organization is shown below in a tabular form:
| CNS germ cell tumor | |
|---|---|
| Germinoma | |
| Pure with syncytiotrophoblasts | |
| Nongerminomatous germ cell tumors | |
| Teratoma- Mature and malignant | |
| Embryonal carcinoma | |
| Yolk sac tumor/endodermal sinus tumor | |
| Choriocarcinoma | |
- Based on the tumor markers secreted into the cerebrospinal fluid (CSF) and serum, as well as by the presence of histochemical markers on tumor cells, intracranial germ cell tumors may be classified into either secreting or non secreting tumors.
- Secreted tumor markers measured in the CSF and serum include beta-human chorionic gonadotropin (beta-hCG) and alpha-fetoprotein (AFP), and immunohistochemistry is used to detect placental alkaline phosphatase (PLAP) and c-Kit on tumor cells. Secreting tumors are commonly defined as germ cell tumors with CSF beta-hCG level >50 international unit/L and/or a CSF AFP >10 microg/L.
- Pure germinomas generally are associated with absent beta-hCG and AFP levels in both serum and CSF. Although an elevated AFP in either the CSF and serun rules out a pure germinoma, a minority of germinomas are associated with elevated beta-hCG levels in the serum and/or CSF.[5]
| Tumor type | Marker | |||
|---|---|---|---|---|
| b-HCG | AFP | PLAP | c-kit | |
| Pure germinoma | - | - | +/- | + |
| Germinoma(syncytiotrophoblastic) | + | - | +/- | + |
| Endodermal sinus tumor | - | + | +/- | - |
| Choriocarcinoma | + | - | +/- | - |
| Embryonal carcinoma | - | - | + | - |
| Mixed GCT | +/- | +/- | +/- | +/- |
| Mature teratoma | - | - | - | - |
| Immature teratoma | +/- | +/- | - | +/- |
References
- ↑ 1.0 1.1 Louis, David N.; Ohgaki, Hiroko; Wiestler, Otmar D.; Cavenee, Webster K.; Burger, Peter C.; Jouvet, Anne; Scheithauer, Bernd W.; Kleihues, Paul (2007). "The 2007 WHO Classification of Tumours of the Central Nervous System". Acta Neuropathologica. 114 (2): 97–109. doi:10.1007/s00401-007-0243-4. ISSN 0001-6322.
- ↑ 2.0 2.1 Jennings MT, Gelman R, Hochberg F (1985). "Intracranial germ-cell tumors: natural history and pathogenesis". J Neurosurg. 63 (2): 155–67. doi:10.3171/jns.1985.63.2.0155. PMID 2991485.
- ↑ 3.0 3.1 Hoffman HJ, Otsubo H, Hendrick EB, Humphreys RP, Drake JM, Becker LE; et al. (1991). "Intracranial germ-cell tumors in children". J Neurosurg. 74 (4): 545–51. doi:10.3171/jns.1991.74.4.0545. PMID 1848284.
- ↑ Villano JL, Propp JM, Porter KR, Stewart AK, Valyi-Nagy T, Li X; et al. (2008). "Malignant pineal germ-cell tumors: an analysis of cases from three tumor registries". Neuro Oncol. 10 (2): 121–30. doi:10.1215/15228517-2007-054. PMC 2613814. PMID 18287340.
- ↑ Ogino H, Shibamoto Y, Takanaka T, Suzuki K, Ishihara S, Yamada T; et al. (2005). "CNS germinoma with elevated serum human chorionic gonadotropin level: clinical characteristics and treatment outcome". Int J Radiat Oncol Biol Phys. 62 (3): 803–8. doi:10.1016/j.ijrobp.2004.10.026. PMID 15936563.