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==Overview==
==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 nonsecreting tumors. Based on the prognosis of the tumor, intracranial germ cell tumors may be classified into either good, intermediate, or poor prognosis.<ref name="LouisOhgaki2007">{{cite journal|last1=Louis|first1=David N.|last2=Ohgaki|first2=Hiroko|last3=Wiestler|first3=Otmar D.|last4=Cavenee|first4=Webster K.|last5=Burger|first5=Peter C.|last6=Jouvet|first6=Anne|last7=Scheithauer|first7=Bernd W.|last8=Kleihues|first8=Paul|title=The 2007 WHO Classification of Tumours of the Central Nervous System|journal=Acta Neuropathologica|volume=114|issue=2|year=2007|pages=97–109|issn=0001-6322|doi=10.1007/s00401-007-0243-4}}</ref><ref name="pmid2991485">{{cite journal| author=Jennings MT, Gelman R, Hochberg F| title=Intracranial germ-cell tumors: natural history and pathogenesis. | journal=J Neurosurg | year= 1985 | volume= 63 | issue= 2 | pages= 155-67 | pmid=2991485 | doi=10.3171/jns.1985.63.2.0155 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2991485  }} </ref><ref name="pmid1848284">{{cite journal| author=Hoffman HJ, Otsubo H, Hendrick EB, Humphreys RP, Drake JM, Becker LE et al.| title=Intracranial germ-cell tumors in children. | journal=J Neurosurg | year= 1991 | volume= 74 | issue= 4 | pages= 545-51 | pmid=1848284 | doi=10.3171/jns.1991.74.4.0545 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1848284  }} </ref>
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.<ref name="LouisOhgaki2007">{{cite journal|last1=Louis|first1=David N.|last2=Ohgaki|first2=Hiroko|last3=Wiestler|first3=Otmar D.|last4=Cavenee|first4=Webster K.|last5=Burger|first5=Peter C.|last6=Jouvet|first6=Anne|last7=Scheithauer|first7=Bernd W.|last8=Kleihues|first8=Paul|title=The 2007 WHO Classification of Tumours of the Central Nervous System|journal=Acta Neuropathologica|volume=114|issue=2|year=2007|pages=97–109|issn=0001-6322|doi=10.1007/s00401-007-0243-4}}</ref><ref name="pmid2991485">{{cite journal| author=Jennings MT, Gelman R, Hochberg F| title=Intracranial germ-cell tumors: natural history and pathogenesis. | journal=J Neurosurg | year= 1985 | volume= 63 | issue= 2 | pages= 155-67 | pmid=2991485 | doi=10.3171/jns.1985.63.2.0155 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2991485  }} </ref><ref name="pmid1848284">{{cite journal| author=Hoffman HJ, Otsubo H, Hendrick EB, Humphreys RP, Drake JM, Becker LE et al.| title=Intracranial germ-cell tumors in children. | journal=J Neurosurg | year= 1991 | volume= 74 | issue= 4 | pages= 545-51 | pmid=1848284 | doi=10.3171/jns.1991.74.4.0545 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1848284  }} </ref>


==Classification==
==Classification==
Based on the histology, germinoma may be classified according to World Health Organization into two groups:<ref name="LouisOhgaki2007">{{cite journal|last1=Louis|first1=David N.|last2=Ohgaki|first2=Hiroko|last3=Wiestler|first3=Otmar D.|last4=Cavenee|first4=Webster K.|last5=Burger|first5=Peter C.|last6=Jouvet|first6=Anne|last7=Scheithauer|first7=Bernd W.|last8=Kleihues|first8=Paul|title=The 2007 WHO Classification of Tumours of the Central Nervous System|journal=Acta Neuropathologica|volume=114|issue=2|year=2007|pages=97–109|issn=0001-6322|doi=10.1007/s00401-007-0243-4}}</ref><ref name="pmid2991485">{{cite journal| author=Jennings MT, Gelman R, Hochberg F| title=Intracranial germ-cell tumors: natural history and pathogenesis. | journal=J Neurosurg | year= 1985 | volume= 63 | issue= 2 | pages= 155-67 | pmid=2991485 | doi=10.3171/jns.1985.63.2.0155 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2991485  }} </ref><ref name="pmid1848284">{{cite journal| author=Hoffman HJ, Otsubo H, Hendrick EB, Humphreys RP, Drake JM, Becker LE et al.| title=Intracranial germ-cell tumors in children. | journal=J Neurosurg | year= 1991 | volume= 74 | issue= 4 | pages= 545-51 | pmid=1848284 | doi=10.3171/jns.1991.74.4.0545 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1848284  }} </ref>
*Based on the histology, germinoma may be classified according to World Health Organization into two groups:<ref name="LouisOhgaki2007">{{cite journal|last1=Louis|first1=David N.|last2=Ohgaki|first2=Hiroko|last3=Wiestler|first3=Otmar D.|last4=Cavenee|first4=Webster K.|last5=Burger|first5=Peter C.|last6=Jouvet|first6=Anne|last7=Scheithauer|first7=Bernd W.|last8=Kleihues|first8=Paul|title=The 2007 WHO Classification of Tumours of the Central Nervous System|journal=Acta Neuropathologica|volume=114|issue=2|year=2007|pages=97–109|issn=0001-6322|doi=10.1007/s00401-007-0243-4}}</ref><ref name="pmid2991485">{{cite journal| author=Jennings MT, Gelman R, Hochberg F| title=Intracranial germ-cell tumors: natural history and pathogenesis. | journal=J Neurosurg | year= 1985 | volume= 63 | issue= 2 | pages= 155-67 | pmid=2991485 | doi=10.3171/jns.1985.63.2.0155 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2991485  }} </ref><ref name="pmid1848284">{{cite journal| author=Hoffman HJ, Otsubo H, Hendrick EB, Humphreys RP, Drake JM, Becker LE et al.| title=Intracranial germ-cell tumors in children. | journal=J Neurosurg | year= 1991 | volume= 74 | issue= 4 | pages= 545-51 | pmid=1848284 | doi=10.3171/jns.1991.74.4.0545 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1848284  }} </ref>
*Germinomas
:*Germinomas
*Nongerminomatous germ cell tumors
:*Nongerminomatous germ cell tumors
*Tumors that consists of more than one of the above histological types are termed mixed GCTs.
*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
*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
*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.<ref name="pmid18287340">{{cite journal| author=Villano JL, Propp JM, Porter KR, Stewart AK, Valyi-Nagy T, Li X et al.| title=Malignant pineal germ-cell tumors: an analysis of cases from three tumor registries. | journal=Neuro Oncol | year= 2008 | volume= 10 | issue= 2 | pages= 121-30 | pmid=18287340 | doi=10.1215/15228517-2007-054 | pmc=PMC2613814 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18287340  }} </ref>  
*Mixed germinomas and nongerminomatous germ cell tumors NGGCTs represent approximately 20% of CNS germ cell tumors.<ref name="pmid18287340">{{cite journal| author=Villano JL, Propp JM, Porter KR, Stewart AK, Valyi-Nagy T, Li X et al.| title=Malignant pineal germ-cell tumors: an analysis of cases from three tumor registries. | journal=Neuro Oncol | year= 2008 | volume= 10 | issue= 2 | pages= 121-30 | pmid=18287340 | doi=10.1215/15228517-2007-054 | pmc=PMC2613814 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18287340  }} </ref>  
Classification of germinoma according to World Health Organization is shown below in a tabular form:
* Classification of germinoma according to World Health Organization is shown below in a tabular form:
{| style="border: 0px; font-size: 90%; margin: 3px; width: 600px" align=center
{| style="border: 0px; font-size: 90%; margin: 3px; width: 600px" align=center
|valign=top|
|valign=top|
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| style="padding: 5px 5px; background: #F5F5F5;"colspan="2" | Teratoma- Mature and malignant
| style="padding: 5px 5px; background: #F5F5F5;"colspan="2" | Teratoma- Mature and malignant
|-
|-
|style="padding: 5px 5px; background: #F5F5F5;"colspan="2" | Embryonal carcinoma
|style="padding: 5px 5px; background: #F5F5F5;"colspan="2" | [[Embryonal carcinoma]]
|-
|-
| style="padding: 5px 5px; background: #F5F5F5;"colspan="2"| Yolk sac tumor/endodermal sinus tumor
| style="padding: 5px 5px; background: #F5F5F5;"colspan="2"| [[Yolk sac tumor]]/[[endodermal sinus tumor]]
|-
|-
| style="padding: 5px 5px; background: #F5F5F5;"colspan="2" | Choriocarcinoma
| style="padding: 5px 5px; background: #F5F5F5;"colspan="2" | [[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 nonsecreting 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.
*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.
*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.<ref name="pmid15936563">{{cite journal| author=Ogino H, Shibamoto Y, Takanaka T, Suzuki K, Ishihara S, Yamada T et al.| title=CNS germinoma with elevated serum human chorionic gonadotropin level: clinical characteristics and treatment outcome. | journal=Int J Radiat Oncol Biol Phys | year= 2005 | volume= 62 | issue= 3 | pages= 803-8 | pmid=15936563 | doi=10.1016/j.ijrobp.2004.10.026 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15936563  }} </ref>
*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.<ref name="pmid15936563">{{cite journal| author=Ogino H, Shibamoto Y, Takanaka T, Suzuki K, Ishihara S, Yamada T et al.| title=CNS germinoma with elevated serum human chorionic gonadotropin level: clinical characteristics and treatment outcome. | journal=Int J Radiat Oncol Biol Phys | year= 2005 | volume= 62 | issue= 3 | pages= 803-8 | pmid=15936563 | doi=10.1016/j.ijrobp.2004.10.026 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15936563  }} </ref>




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|style="padding: 5px 5px; background: #F5F5F5;"| +
|style="padding: 5px 5px; background: #F5F5F5;"| +
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | Endodermal sinus tumor
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | [[Endodermal sinus tumor]]
|style="padding: 5px 5px; background: #F5F5F5;"| -
|style="padding: 5px 5px; background: #F5F5F5;"| -
|style="padding: 5px 5px; background: #F5F5F5;"| +
|style="padding: 5px 5px; background: #F5F5F5;"| +
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|style="padding: 5px 5px; background: #F5F5F5;"| -
|style="padding: 5px 5px; background: #F5F5F5;"| -
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | Choriocarcinoma
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | [[Choriocarcinoma]]
|style="padding: 5px 5px; background: #F5F5F5;"| +
|style="padding: 5px 5px; background: #F5F5F5;"| +
| style="padding: 5px 5px; background: #F5F5F5;"|-
| style="padding: 5px 5px; background: #F5F5F5;"|-
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|style="padding: 5px 5px; background: #F5F5F5;" |-
|style="padding: 5px 5px; background: #F5F5F5;" |-
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | Embryonal carcinoma
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | [[Embryonal carcinoma]]
| style="padding: 5px 5px; background: #F5F5F5;"|-
| style="padding: 5px 5px; background: #F5F5F5;"|-
| style="padding: 5px 5px; background: #F5F5F5;"|-
| style="padding: 5px 5px; background: #F5F5F5;"|-
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| style="padding: 5px 5px; background: #F5F5F5;"|-
| style="padding: 5px 5px; background: #F5F5F5;"|-
| style="padding: 5px 5px; background: #F5F5F5;"|+/-
| style="padding: 5px 5px; background: #F5F5F5;"|+/-
|}
Based on the prognosis of the tumor, intracranial germ cell tumors may be classified into either good, intermediate, or poor prognosis. Pure germinomas carry a better prognosis than NGGCTs. Secreting germ cell tumors GCTs are generally considered to behave more aggressively and carry a poorer prognosis than nonsecreting germ cell tumors GCTs.<ref name="pmid9046301">{{cite journal| author=Matsutani M, Sano K, Takakura K, Fujimaki T, Nakamura O, Funata N et al.| title=Primary intracranial germ cell tumors: a clinical analysis of 153 histologically verified cases. | journal=J Neurosurg | year= 1997 | volume= 86 | issue= 3 | pages= 446-55 | pmid=9046301 | doi=10.3171/jns.1997.86.3.0446 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9046301  }} </ref><ref name="pmid11767296">{{cite journal| author=Matsutani M, Japanese Pediatric Brain Tumor Study Group| title=Combined chemotherapy and radiation therapy for CNS germ cell tumors--the Japanese experience. | journal=J Neurooncol | year= 2001 | volume= 54 | issue= 3 | pages= 311-6 | pmid=11767296 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11767296  }} </ref>
{| style="border: 0px; font-size: 90%; margin: 3px; width: 600px" align=center
|valign=top|
|+
! style="background: #4479BA; width: 10%;" | {{fontcolor|#FFF|Prognosis}}
! style="background: #4479BA; width: 5%;" | {{fontcolor|#FFF|Type of intracranial germ cell tumors}}
! style="background: #4479BA; width: 5%;" | {{fontcolor|#FFF|Survival %}}
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |
:Good prognosis
| style="padding: 5px 5px; background: #F5F5F5;" |
Pure germinomas
Mature teratomas
| style="padding: 5px 5px; background: #F5F5F5;" | 90 %
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
:Poor prognosis
| style="padding: 5px 5px; background: #F5F5F5;" |
Choriocarcinoma
Yolk sac tumor
Embryonal carcinoma
Mixed Nongerminomatous germ cell tumors composed of choriocarcinoma, yolk sac tumor, and embryonal carcinoma
| style="padding: 5px 5px; background: #F5F5F5;" |40 %
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
:Intermediate prognosis
| style="padding: 5px 5px; background: #F5F5F5;" |
*Germinoma with syncytiotrophoblastic giant cells
*Immature teratoma
*Mixed tumors mainly composed of germinoma or teratoma
*Teratoma with malignant transformation
| style="padding: 5px 5px; background: #F5F5F5;" |70 %
|-
|}
|}


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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. ↑ 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. ↑ 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. ↑ 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.
  4. ↑ 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.
  5. ↑ 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.


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