Intracranial Germ Cell Tumors in Children: An Immunohistochemical and Electron Microscopic Study

Abstract

From a review of a series of 1,474 intracranial tumors occurring in children, we identified 49 patients (3.3 %) with primary intracranial germ cell tumors: 65% germinomatous, 26% nongerminomatous (8 teratomas, 3 endodermal sinus, and 2 choriocarcinomas), and 8°10 mixed. Placental alkaline phosphatase was present in all germinomas tested. Human chorionic gonadotropin was identified in 7 patients, cytokeratin in 6, and α-fetoprotein in 4. The results of immunostaining with antisera against glial fibrillary acidic protein, desmin, and vimentin were essentially negative. Electron microscopy played an important role in confirming the diagnosis in patients with endodermal sinus and mixed tumors. The correct identification of mixed and non-germ-cell tumors requires adequate tumor sampling and proper preparation of tissue for immunohistochemical and electron microscopic examination.

Cerebral Composite Atypical Teratoid/Rhabdoid Tumor and Yolk Sac Tumor in the Frontal Lobe of an Infant-Case Report-

“…1,3,4,7) Like the malignant components of mixed GCTs, AT/RT components also seem to worsen the prognosis. In addition, spinal dissemination is often present at the onset and also worsens the prognosis.…”

“…Aggressive tumor resection and identification of tumor components rarely improve the prognosis because of potential for rapid recurrence. [1][2][3][4][5][7][8][9]12,14,[16][17][18] In our patient, we performed total removal followed by ICE chemotherapy on the basis of the poor prognosis according to the World Health Organization grading system, but did not perform irradiation because of the patient's age. 7,15,18) …”

“…8) Most GCTs are derived from remnants of fetal germ cell migration and occur in the pineal and suprasellar region (80-90%), followed by the basal ganglia. [3][4][5][6][7][8]11,13,15) Atypical teratoid/rhabdoid tumor (AT/RT) of the central nervous system is a new entity of malignant tumors usually occurring in the posterior fossa of children younger than 2 years, usually males. 1,2,9,10,12) AT/RT tends to occur in the posterior fossa including the cerebellum and brain stem, and is characterized by cyst formation, intratumoral hemorrhage, calcification, and inhomogeneous enhancement.…”

Intracranial Germ Cell Tumors: A Comprehensive Review of Proposed Embryologic Derivation

“…A review of five large published series on IGCTs during the last 10 years [2,3,5,7,9] shows a total of 276 cases. Analysis of these studies reveals that 49% of the tumors were located in the pineal region, 34% in the suprasellar region, and 5% in both regions which is in agreement with a larger review performed by Jennings et al [11].…”

Intracranial germ-cell tumours — treatment results and residuals

“…Germ-cell turnouts constitute less than 5% of childhood primary brain tumours both in Europe and in the U.S.A. [2,4,12,24]. Two-cell germinoma arising in the pineal or suprasellar region is the most common type, comprising over 50% of all germ-cell tumours [2,11,19,28].…”