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


  • 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.
  • 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.


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 +/- +/- - +/-

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]. Secreting GCTs are generally considered to behave more aggressively and carry a poorer prognosis than nonsecreting GCTs.


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