Intracranial Germinoma in Children and Diabetes insipidus: Clinical Description and Search for Tumor Markers

Abstract Background The Delphi consensus statements on the management of germ cell tumors (GCTs) failed to reach agreements on the statement that the cases with (i) pineal and neurohypophyseal bifocal lesion, (ii) with diabetes insipidus, and (iii) with negative tumor markers can be diagnosed as germinoma without histological verification. To answer this, multicenter retrospective analysis was performed. Methods A questionnaire on clinical findings, histological diagnosis, and details of surgical procedures was sent to 86 neurosurgical and 35 pediatrics departments in Japan. Results Fifty-one institutes reported 132 cases that fulfilled the 3 criteria. Tissue sampling was performed in 91 cases from pineal (n = 44), neurohypophyseal (n = 32), both (n = 6), and distant (n = 9) lesions. Histological diagnosis was established in 89 cases: pure germinoma or germinoma with syncytiotrophoblastic giant cells in 82 (92.1%) cases, germinoma and mature teratoma in 2 cases, and granulomatous inflammation in 2 cases. Histological diagnosis was not established in 2 cases. Although no tumors other than GCTs were identified, 3 (3.4%) patients had non-germinomatous GCTs (NGGCTs). None of the patients developed permanent complications after endoscopic or stereotactic biopsy. Thirty-nine patients underwent simultaneous procedure for acute hydrocephalus without permanent complications, and hydrocephalus was controlled in 94.9% of them. Conclusion All patients who fulfilled the 3 criteria had GCTs or granulomatous inflammation, but not other types of tumors. However, no fewer than 3.4% of the patients had NGGCTs. Considering the safety and the effects of simultaneous procedures for acute hydrocephalus, biopsy was recommended in such patients.

Download Full-text

Diabetes insipidus and increased serum levels of leptin and lactate-dehydrogenase (LDH) in an adolescent boy with a primary intracranial germinoma. Case Report and an endocrinological revaluation of literature

Journal of Endocrinological Investigation ◽

10.1007/bf03343609 ◽

1999 ◽

Vol 22 (7) ◽

pp. 558-561

Author(s):

C. Carella ◽

M. Rotondi ◽

A. Del Buono ◽

A. M. Sinisi ◽

M. L. Del Basso De Caro ◽

...

Keyword(s):

Case Report ◽

Lactate Dehydrogenase ◽

Diabetes Insipidus ◽

Serum Levels ◽

Intracranial Germinoma

Download Full-text

Placental alkaline phosphatase levels in cerebrospinal fluid can have a decisive role in the differential diagnosis of intracranial germ cell tumors

Journal of Neurosurgery ◽

10.3171/2018.3.jns172520 ◽

2019 ◽

Vol 131 (3) ◽

pp. 687-694 ◽

Cited By ~ 8

Author(s):

Yasuo Aihara ◽

Sinichiro Watanabe ◽

Kosaku Amano ◽

Kana Komatsu ◽

Kentaro Chiba ◽

...

Keyword(s):

Alkaline Phosphatase ◽

Germ Cell ◽

Tumor Marker ◽

Tumor Markers ◽

Germ Cell Tumors ◽

Diagnostic Value ◽

Placental Alkaline Phosphatase ◽

Intracranial Germinoma ◽

Intracranial Germ Cell Tumors ◽

Very High

OBJECTIVEPlacental alkaline phosphatase (PLAP) in CSF can provide a very high diagnostic value in cases of intracranial germ cell tumors (GCTs), especially in pure germinomas, to the level of not requiring histological confirmation. Unlike other tumor markers, reliable data analysis with respect to the diagnostic value of PLAP serum or CSF levels has not been available until now. This is the first systematic and comprehensive study examining the diagnostic value of CSF PLAP in patients with intracranial GCTs.METHODSFrom 2004 to 2014, 74 patients (average age 19.6 ± 10.6 years) with intracranial GCTs were evaluated using PLAP from their CSF and histological samples. Chemiluminescent enzyme immunoassay was utilized to measure CSF PLAP in the following tumor sites: pineal (n = 32), pituitary stalk, suprasellar (n = 16), basal ganglia (n = 15), intraventricular (n = 9), and cerebellar (n = 5) regions. In addition to classifying GCT cases, all patients underwent tumor biopsy for correlation with tumor marker data.RESULTSPLAP in combination with other tumor markers resulted in extremely high sensitivity and specificity of the diagnostic value of intracranial GCTs. Intracranial GCT cases were classified into 1) germinomas, both “pure” and syncytiotrophoblastic giant cell types (n = 38); 2) nongerminomatous GCTs, choriocarcinomas (n = 9) and teratomas (n = 4); and 3) nongerminomas, other kinds of tumors (n = 23). Consequently, all patients received chemoradiation therapy based on elevation of PLAP and the histopathological results. It was also speculated that the level of PLAP could show the amount of intracranial germ cell components of a GCT. PLAP was 100% upregulated in all intracranial germinoma cases. The absence of CSF PLAP proved that the tumor was not a germinoma.CONCLUSIONSThe current study is the first systematic and comprehensive examination of the diagnostic value of the tumor marker PLAP in pediatric patients with intracranial GCT. Using the level of PLAP in CSF, we were able to detect the instances of intracranial germinoma with very high reliability, equivalent to a pathological diagnosis.

Download Full-text

Effect of ADH on Rat Renal Papilla, an Ultrastructural and Cytochemical Study

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100072496 ◽

1973 ◽

Vol 31 ◽

pp. 410-411

Author(s):

C. N. Sun ◽

H. J. White ◽

E. J. Towbin

Keyword(s):

Electron Microscopy ◽

Diabetes Insipidus ◽

Renal Papilla ◽

Milk Diet ◽

Intercellular Spaces ◽

Cytochemical Study ◽

Collecting Tubule ◽

Concentrate Urine ◽

Staining Techniques ◽

Collecting Tubules

Diabetes insipidus and compulsive water drinking are representative of two categories of antidiuretic hormone (ADH) lack. We studied a strain of rats with congenital diabetes insipidus homozygote (DI) and normal rats on an isocaloric fortified dilute milk diet. In both cases, the collecting tubules could not concentrate urine. Special staining techniques, Alcian Blue-PAS for light microscopy and lanthanum nitrate for electron microscopy were used to demonstrate the changes in interstitial mucopolysaccharides (MPS). The lanthanum staining was done according to the method of Khan and Overton.Electron microscopy shows cytoplasmic lesions, vacules, swelling and degenerating mitochondria and intercellular spaces (IS) in the collecting tubule cells in DI and rats on milk diet.

Download Full-text