Skip to main content
SpringerLink
Log in

Morphologic features of human chorionic gonadotropin-or alphafetoprotein-producing germ cell tumors of the central nervous system: histological heterogeneity and surgical meaning

  • Original Article
  • Published:
Brain Tumor Pathology Aims and scope Submit manuscript

Abstract

Our study of germ cell tumors (GCT) of the central nervous system (CNS) investigated the relationship between tumor histology and patient serum titers of human chorionic gonadotropin (HGC) and alpha-fetoprotein (AFP). Thirty-five patients were enrolled. Their serum titers of HCG (mIU/ml) and/or AFP (ng/ml) before initial treatment were available, as were tumor specimens obtained before the administration of adjuvant therapy. They were divided into three groups, depending on whether HCG alone (group H), AFP alone (group A), or both HCG and AFP (group HA) were detected. Each group was subdivided into three groups: patients in group I had H, A, and/or HA titers below 9.9; patients in group II/III had titers from 10.0 to 999; and those in group IV had titers of 1000 or more. Serial sections of tissue specimens were repeatedly stained, mainly with hematoxylin and eosin (H-E) stain, HCG immunostain, and AFP immunostain. There were seven patients in the H-I group and five in H-II/III. Of these 12 patients, 11 had germinomas (G) and one had an embryonal carcinoma (EC). Five patients were included in group A; one was classified as A-II/III and had a germinoma, and the remaining four patients were in A-IV and had yolk sac tumors (YST) or mixed GCT consisting mainly of YST or EC (MXGCT-YST, EC). The HA group consisted of 18 patients. Three were classified as HA-I and had germinomas; nine HA-II/III patients had T or MXGCT-T; and six HA-IV patients had choriocarcinoma (CC), YST, MXGCT-CC, or MXGCT-YST. Throughout the study, the situations for the elevated serum titers could be elucidated in only four cases (three in group A-IV and one in group HA-IV). These results led to the conclusion that serologic evaluation is superior to morphologic evaluation in diagnosing marker-producing GCTs. From a diagnostic perspective, the role of surgery is to verify the HCG-and AFP-immunonegative tissue in patients with G, T, and EC.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Segal R, Lukka H, Klotz LH, et al (2001) Surveillance programs for early stage non-seminomatous testicular cancer—a practice guideline. Can J Urol 8:1184–1192

    PubMed  CAS  Google Scholar 

  2. Arita N, Ushio Y, Hayakawa T, et al (1980) Serum levels of alphafetoprotein, human chorionic gonadotropin and carcinoembryonic antigen in patients with primary intracranial germ cell tumors. Oncodev Bio Med 1:235–240

    CAS  Google Scholar 

  3. Matsutani M, Sano K, Takakura K, et al (1997) Primary intracranial germ cell tumors: a clinical analysis of 153 histologically verified cases. J Neurosurg 86:446–455

    PubMed  CAS  Google Scholar 

  4. Appuzzo ML, Stieq PE, Starr P, et al (1996) Surgery of the soul's cistern. Neurosurgery 39:1022–1029

    Article  Google Scholar 

  5. Mostofy FK (1980) Pathology of germ cell tumors of testis: a progress report. Cancer 45:1735–1754

    Google Scholar 

  6. Rosenblum MK, Matsutani M, Van Meir EG (2000) CNS germ cell tumours. In: Kleihues P, Cavenee WK (eds) Pathology and genetics of tumours of the nervous system. IARCP Press, Lyon, pp 207–214

    Google Scholar 

  7. Yoshida J, Sugita K, Kobayashi T, et al (1993) Prognosis of intracranial germ cell tumours: effectiveness of chemotherapy with cisplatin and etoposide (CDDP and VP-16). Acta Neurochir 120:111–117

    Article  CAS  Google Scholar 

  8. Balmaceda C, Heller G, Rosenblum M, et al (1996) Chemotherapy without irradiation—a novel approach for newly diagnosed CNS germ cell tumors: results of an international cooperative trial. The First International Central Nervous System Germ Cell Tumor Study. J Clin Oncol 14:2908–2915

    CAS  Google Scholar 

  9. Buckner JC, Peethambaram PP, Smithson WA, et al (1999) Phase II trial of primary chemotherapy followed by reduced-dose radiation for CNS germ cell tumors. J Clin Oncol 17:933–940

    PubMed  CAS  Google Scholar 

  10. Vijayaraghavan S, Brock C, Monson JP, et al (1993) Does the rapid response to cisplatin-based chemotherapy justify its use as primary treatment for intracranial germ-cell tumors? Q J Med 86:801–810

    PubMed  CAS  Google Scholar 

  11. Suguiyama K, Arita K, Kurisu K, et al (2000) A case of embryonal carcinoma mimicking a HCG-producing germinoma (in Japanese). Jpn J Neurosurg 9:768–774

    Google Scholar 

  12. Nogales FF, Matilla AM, Nogales-Oritiz, et al (1978) Yolk sac tumors with polyvesicular vitellin patterns. Hum Pathol 9:553–566

    PubMed  Google Scholar 

  13. Prat J, Bhan AK, Dickersin GR, et al (1982) Hepatoid yolk sac tumor of ovary (endodermal sinus tumor with hepatoid differentiation). A light microscopic, ultrastructural and immunohistochemical study of seven cases. Cancer 50:2355–2368

    Article  PubMed  CAS  Google Scholar 

  14. Fijimaki T, Matsutani M, Funada N, et al (1994) CT and MRI features of intracranial germ cell tumor. J Neurooncol 19:217–226

    Article  Google Scholar 

  15. Sumida M, Uozumi T, Kiya K, et al (1995) MRI of intracranial germ cell tumors. Neurodadiology 37:32–37

    Article  CAS  Google Scholar 

  16. Sawamura Y, Shirato H, Ikeda J, et al (1998) Induction chemotherapy followed by reduced-volume radiation therapy for newly diagnosed central nervous system germinoma. J Neurosurg 88:66–72

    Article  PubMed  CAS  Google Scholar 

  17. Sawamura Y, Ikeda J, Shirato H, et al (1998) Germ cell tumours of the central nervous system: treatment consideration based on 111 cases and their long-term clinical outcomes. Eur J Cancer 34:104–110

    Article  PubMed  CAS  Google Scholar 

  18. Sawamura Y, Kato T, Ikeda J, et al (1998) Teratomas of the central nervous system: treatment consideration based on 34 cases. J Neurosurg 89:728–737

    PubMed  CAS  Google Scholar 

  19. Marina NM, Cushing B, Giller R, et al (1999) Complete surgical excision is effective treatment for children with immature teratomas with or without malignant elements: a Pediatric Oncology Group/Children's Cancer Group Study. J Clin Oncol 17:2137–2143

    PubMed  CAS  Google Scholar 

  20. Ushio Y, Kochi M, Kuratsu J, et al (1999) Preliminary observations for a new treatment in children with primary intracranial yolk sac tumor of embryonal carcinoma. Report of five cases. J Neurosurg 90:133–137

    Article  PubMed  CAS  Google Scholar 

  21. Herrmann H-D, Westphal M, Winkler K, et al (1994) Treatment of nongerminomatous germ-cell tumors of the pineal region. Neurosurgery 34:524–529

    PubMed  CAS  Google Scholar 

  22. Friedman JA, Lynch JJ, Buckner JC, et al (2001) Management of malignant pineal germ cell tumors with residual mature teratoma. Neurosurgery 48:518–523

    Article  PubMed  CAS  Google Scholar 

  23. Andre F, Fizazi K, Culine S, et al (2000) The growing teratoma syndrome: results of therapy and long-term follow-up of 33 patients. Eur J Cancer 36:1389–1394

    Article  PubMed  CAS  Google Scholar 

  24. Sawamura Y, de Tribolet N, Ishi N, et al (1997) Management of primary intracranial germinomas: diagnostic surgery or radical resection? J Neurosurg 87:262–266

    PubMed  CAS  Google Scholar 

  25. Burger PC, Scheithauer BW (1994) Tumors of the central nervous system: germ cell tumors. Armed Forces Institute of Pathology, Washington, DC, pp 251–257

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Hiroshima University Medical Hospital, 1-2-3 Kasumi, Minami-ku, 734-8551, Hiroshima, Japan

    Kazuhiko Sugiyama, Kazunori Arita, Atsushi Tominaga, Ryosuke Hanaya, Eiji Taniguchi, Tatsunori Okamura, Yoko Itoh, Fumiyuki Yamasaki & Kaoru Kurisu

Authors
  1. Kazuhiko Sugiyama
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kazunori Arita
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Atsushi Tominaga
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ryosuke Hanaya
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Eiji Taniguchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Tatsunori Okamura
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Yoko Itoh
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Fumiyuki Yamasaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Kaoru Kurisu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kazuhiko Sugiyama.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Sugiyama, K., Arita, K., Tominaga, A. et al. Morphologic features of human chorionic gonadotropin-or alphafetoprotein-producing germ cell tumors of the central nervous system: histological heterogeneity and surgical meaning. Brain Tumor Pathol 18, 115–122 (2001). https://doi.org/10.1007/BF02479424

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02479424

Key words

Search

Navigation