Novel Diagnostic Methods and Posttreatment Clinical Phenotypes Among Intracranial Germ Cell Tumors
| Autor: | Avital Perry, Hirokazu Takami, Caterina Giannini, David J. Daniels, Christopher S. Graffeo |
|---|---|
| Přispěvatelé: | Takami H., Perry A., Graffeo C.S., Giannini C., Daniels D.J. |
| Rok vydání: | 2020 |
| Předmět: |
Adult
Male Pathology medicine.medical_specialty Adolescent medicine.medical_treatment Cohort Studies Young Adult 03 medical and health sciences 0302 clinical medicine Cerebrospinal fluid Germ cell tumor medicine Chemotherapy Humans Child Craniotomy Retrospective Studies Brain Neoplasms business.industry Infant Newborn Second-look surgery Infant Histology Middle Aged Neoplasms Germ Cell and Embryonal medicine.disease Combined Modality Therapy Chemotherapy regimen Radiation therapy Phenotype Child Preschool 030220 oncology & carcinogenesis Female Surgery Neurology (clinical) Germ cell tumors business Long-term sequelae 030217 neurology & neurosurgery Cohort study |
| Zdroj: | Neurosurgery. 87:563-572 |
| ISSN: | 1524-4040 0148-396X 1988-2017 |
| Popis: | BACKGROUND: Central nervous system (CNS) germ cell tumors (GCT) are rare and complex pediatric neoplasms, the optimal management of which remains an area of active investigation. OBJECTIVE: To present an updated cohort study, with particular attention to novel diagnostic methods and posttreatment clinical phenotypes. METHODS: A single-institution cohort study of 80 primary, neurosurgically managed, CNS GCTs was conducted at Mayo Clinic, 1988-2017. RESULTS: Postchemotherapy resection (eg, second-look surgery) was frequently required (27.0%), especially after adjuvant therapies for nongerminomatous GCTs (NGGCTs; 14 of 28 cases, excluding mature teratoma) and significantly associated with pineal lesions, as compared to neurohypophyseal or bifocal lesions (43.6%vs 5.9% vs 6.7%, P=.004), a finding that retained statistical significance after adjusting for index extent of resection and histology (P=.04). Essentially every NGGCT case underwent at least 1 craniotomy, either on presentation, as second-look surgery, or following local recurrence. Mature teratomatous tissue was highly incident in second-look specimens (84.2%), even among lesions initially diagnosed as germinomas. Pretreatment cerebrospinal fluid (CSF) cell fraction analysis demonstrated an association between single lesions and neutrophil predominance, whereas nongerminomatous GCTs were associated with increased monocyte fractions. CONCLUSION: CNS GCTs are clinically heterogeneous lesions, resulting in numerous opportunities for improved understanding and clinical management via novel diagnostic and therapeutic protocols. Samples from second-look surgeries for recurrent germinomas frequently demonstrate teratomatous tissue, suggesting possible underdiagnosis of mixed GCTs-particularly among pineal lesions. GCT subtypes demonstrate differential cell fraction distributions on CSF analysis, a novel and perhaps diagnostically helpful finding that requires validation in external cohorts. |
| Databáze: | OpenAIRE |
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