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.

Classification

Based on the histology, germinoma may be classified according to World Health Organization into two groups:

• Germinomas
• Nongerminomatous germ cell tumors

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

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	+/-	+/-	-	+/-

Intracranial GCTs can be further defined by tumor markers secreted into the cerebrospinal fluid (CSF) and serum, as well as by the presence of histochemical markers on tumor cells (table 2). Secreted tumor markers measured in the CSF and serum include alpha-fetoprotein (AFP) and beta-human chorionic gonadotropin (beta-hCG), and immunohistochemistry is used to detect placental alkaline phosphatase (PLAP) and c-Kit on tumor cells. Intracranial GCTs can also be divided into "secreting" and "nonsecreting" tumors. Secreting tumors are commonly defined as GCTs with CSF AFP >10 microg/L (or above the institutional normal range) and/or a CSF beta-hCG level >50 int. unit/L. Secreting GCTs are generally considered to behave more aggressively and carry a poorer prognosis than nonsecreting GCTs.

Pure germinomas generally are associated with absent AFP and beta-hCG levels in both CSF and serum. Although an elevated AFP in either the serum or CSF effectively rules out a pure germinoma, a minority of germinomas are associated with elevated beta-hCG levels in the CSF and/or serum [14]. The source of the elevated beta-hCG is thought to be syncytiotrophoblasts that are associated with germinomas. (See 'Beta-HCG secreting germinomas' below.)

Another classification system commonly used in Japan separates intracranial GCTs into "good", "intermediate", and "poor prognosis" groups [15]. Pure germinomas and mature teratomas are included in the "good prognosis" group. Choriocarcinoma, yolk sac tumor, embryonal carcinoma, and mixed NGGCTs composed mainly of these three histologies are included in the "poor prognosis" group, with all other tumors included in the "intermediate prognosis" group. Patients in the "good prognosis" have over-all survival exceeding 90 percent, while patients in the "intermediate" and "poor prognosis" groups have over-all survival rates of approximately 70 and 40 percent, respectively [15,16].

References

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