Single-institution case series of pituitary biopsy for suspected germinoma in the pediatric population: diagnostic utility, operative risks, and biopsy approaches

Abstract

Little has been reported on the safety and efficacy of pituitary biopsy in the pediatric population for suspected germinoma. An updated review is needed. Patients who underwent biopsy (endoscopic endonasal vs. open craniotomy) for isolated pituitary stalk thickening were identified. Age, pre- and post-operative endocrine status, surgical approach, length of surgery, estimated blood loss, surgical morbidity, length of ICU stay, total length of stay, and pathology reports were reviewed. Nine patients met inclusion criteria. Germinoma diagnosis was rendered in 7 of 9 patients; 1 patient required two biopsy attempts. Two-patients had histology consistent with inflammation and a subsequently self-limited disease course. Average operative time, blood loss, ICU stay and overall length of stay was just over 2 h, 28 mL, 1.6 days and 3.7 days respectively. There were no intraoperative complications and all patients were discharged home. One patient developed new diabetes insipidus post-operatively. Patients who underwent endoscopic biopsy had decreased operative times and shorter hospitalizations. Biopsy for isolated pituitary stalk thickening for suspected germinoma is generally safe with high diagnostic utility. Importantly, 22% of presumed germinomas on imaging yielded alternative diagnoses on biopsy, adding support for pathology-proven data to guide treatment in relevant cases.

Pituitary Stalk Germ Cell Tumors: Retrospective Case Series and Literature Review

“…Although some studies suggested that patients with a pituitary stalk of 6–7 mm receive a pathological examination [ 8 ], whether to perform a surgical biopsy deserves careful weighing. On the one hand, although safe [ 29 ], pituitary biopsy is a difficult operation, especially for a small lesion, clinical diagnosis based on significant tumor size regression after a low dose of irradiation or a short course of chemotherapy is easier to perform. [ 30 , 31 ] On the other hand, partial cases of iGCTs were pathologically diagnosed as hypophysitis [ 10 , 11 , 13 , 17 – 20 , 24 ] or granuloma disease [ 9 , 15 ] at the initial biopsy due to the immune response of the host to germinomas.…”

Molecular Pathology and Targeted Therapies for Personalized Management of Central Nervous System Germinoma

“…The study included 91 patients with available histologic diagnosis, of which 92% were pure germinomas and germinomas with syncytiotrophoblastic giant cells, concluding that a tumour biopsy is recommended to ensure the proper diagnosis [ 69 ]. Another retrospective study revealed that in cases of pituitary germinoma suspected on MRI, the biopsy can reveal another pathology in 22% of the tumours [ 70 ]. Moreover, a fairly recent technique that combines endoscopic biopsy with endoscopic ventriculostomy, using a single trajectory, is considered safe and could become an alternative for the dual procedure in pineal germinomas [ 71 ].…”

Intracranial Germinomas: Diagnosis, Pathogenesis, Clinical Presentation, and Management

“…It is well-known that early discrimination of germinomas from other intracranial neoplasms facilitates the timely initiation of appropriate treatment, thereby contributing to the reduction of morbidity as well as mortality. To this effect, a histological confirmation of germinomas by stereotactic or endoscopic biopsy may be necessary [ 13 ]. Additionally, late side effects of the radiotherapy have attracted increasing attention in recent decades due to the consequently high survival rate [ 14 , 15 ].…”