Comparison of survival outcomes in patients with intracranial germinomas treated with radiation alone versus reduced-dose radiation and chemotherapy

Concern about long-term sequelae of irradiation has led to the use of adjuvant chemotherapy with lower dose irradiation in the treatment of intracranial germinomas. To assess the feasibility of this approach versus radiation only, the survival of 16 evaluable patients (13 boys, 3 girls) with biopsy-proven intracranial germinomas treated at the Hospital for Sick Children was assessed. Between 1977 and 1988, 8 patients were treated with radiation only: 7 received tumour doses between 4000 and 5100 cGy and spinal prophylaxis; 1 received 3060 cGy to the tumour with no prophylaxis. After a median follow-up of 84 months, 7 are in continuous first CR and 1 is in second CR. Between 1988 and 1996, 8 patients received adjuvant platinum- and etoposide-based chemotherapy for two or three cycles followed by local irradiation to the tumour (2500–3500 cGy). After a median follow-up of 40 months, 6 are in continuous first CR and 1 in second CR; 1 has died of progression. Survival outcomes in the two groups are similar. Prospective trials to assess event-free survivals, neurocognitive and neuroendocrine outcomes are needed before definitive treatment recommendations can be made. Received: 24 July 1998     

Mixed germ cell tumors in septum pellucidum after radiochemotherapy of suprasellar germinoma: de novo metachronous or recurrent neoplasms?

Introduction  Mixed germ cell tumors (GCTs) consisting of a germinoma and a mature teratoma in the septum pellucidum have never been described previously; the patient we present here is the first reported example. Case report  This case involves an 18-year-old man who presented with abnormal behavior, impairment in recent memory, and emotional change. Five years ago, he received five cycles of chemotherapy using cisplatin and ectoposide and 24G of local radiotherapy for clinical diagnosis of suprasellar germinoma in another hospital. The tumor was then completely resolute. Magnetic resonance imaging in our hospital revealed a large fatty mass located primarily in the septum pellucidum and some portions of the corpus callosum; a heterogeneous enhancing tumor was observed in the surrounding area. The second tumor was completely removed. The histological diagnosis was mixed GCTs containing the component of a germinoma and a mature teratoma. Conclusion  This case is characterized by a second GCT occurring at a different site and with a different histological type, long after complete resolution of suprasellar germinoma. Although it is very difficult to draw conclusions about the correlation between the first and second GCTs, neurosurgeons should always pay attention to the pathological variety and dynamic pathological changes in GCTs once they start to examine and treat them.     

腹腔镜腹膜后淋巴结清除术9例

目的　探讨采用腹腔镜技术行腹膜后淋巴结清除术治疗I期非精原细胞瘤的方法和效果。　方法　 2 0 0 1年 1月～ 2 0 0 2年 5月 ,对 9例临床诊断为I期非精原细胞瘤的患者行腹腔镜腹膜后淋巴结清除术。　结果　手术均成功 ,平均手术时间 2 60min ,无患者需要输血 ,无严重并发症发生 ,术后平均住院时间 5 5d,术后平均随访 9个月无肿瘤复发。　结论　腹腔镜腹膜后淋巴结清除术非常适宜于治疗I期非精原细胞瘤 ,手术安全、创伤小、效果良好     

颅内生殖细胞瘤21 例临床分析

 目的　探讨颅内生殖细胞瘤的临床病理特点及治疗原则。方法　分析 2 1例患者的临床表现、治疗方法及疗效。结果　全组颅内种植播散率 2 3.8% ,复发率 1 9.0 % ,1、3、5年生存率分别为 95.0 %、84.6%、77.8% ,无脊髓转移。结论　放疗是其主要治疗方法 ,一般应全脑 +局部放疗 ,但无须常规全脊髓预防性照射。     

Germinoma recurrence in the conus medullaris 12 years after remission of primary intracranial lesion in the pituitary

Intracranial germinomas are rare primary central nervous system tumours that are highly sensitive to radiotherapy and chemotherapy. Recurrences are infrequent, with the majority occurring within 5 years. Although multidisciplinary treatments have resulted in good event-free survival, long-term outcomes, over decades, are relatively poorly reported. We present a rare case of a recurrence in the conus medullaris 12 years after complete remission of the primary pituitary germinoma. To the best of our knowledge, this represents the first case of a significantly delayed spinal recurrence, occurring at a very distant and uncommon site, from the primary tumour. This case highlights the importance of long-term follow-up, even after complete remission, in order to identify and limit disability from late spinal recurrences in a relatively young patient population. We consider the literature regarding identifying high risk patients, and the role of craniospinal irradiation in limiting late spinal recurrences.     

鞍上生殖细胞瘤的影像诊断及误诊分析

目的：研究鞍上生殖细胞瘤的CT、MRI影像特征，分析主要误诊原因。方法：回顾性分析14例影像误诊，而经手术证实的鞍上生殖细胞瘤病例，总结其CT、MRI影像学表现及误诊原因。结果：本组14例鞍上生殖细胞瘤好发于儿童和青少年（平均年龄15.5岁），女性（n=8）稍多于男性。临床症状以多饮多尿（n=8）、闭经（n=3）等下丘脑-垂体轴受损症状及视力下降（n=7）为主。血清或脑脊液β-HCG（n=4）可升高。其影像表现以实性为主（n=10），部分可见囊变（n=4），钙化少见（n=2）。CT平扫呈稍高密度，MRI扫描T1、T2均为等或稍高信号。增强扫描呈明显均匀强化（n=7）。本组鞍上生殖细胞瘤误诊原因包括：①因检查不全未明确诊断（n=6）；②因年龄或钙化误诊为颅咽管瘤（n=6）；③因“雪人征”误诊为垂体瘤（n=3）；④因年龄及其他原因误诊为胶质瘤（n=3）。结论：鞍上生殖细胞瘤易误诊为颅咽管瘤、垂体瘤、胶质瘤等，需要在完善影像学检查的基础上，结合患者年龄、临床表现、实验室检查及影像表现综合诊断。     

颅内生殖细胞瘤的磁共振诊断

目的探讨MRI对颅内生殖细胞瘤的诊断价值。方法经病理或临床证实的颅内生殖细胞瘤21例,回顾性分析其治疗前MRI表现。结果 21例中,8例位于松果体区,6例位于下丘脑区,5例同时累及松果体及下丘脑区,2例发生于基底核区。3例生殖细胞瘤合并脑膜转移。发生在松果体区或(和)下丘脑区的生殖细胞瘤典型的MRI表现为肿瘤信号均匀,边界清楚,增强后明显强化,本组共14例表现较为典型,另5例及基底核区2例生殖细胞瘤发生囊变。结论 MRI对颅内生殖细胞瘤的诊断与鉴别诊断具有重要的价值。尤其是当松果体及下丘脑区同时出现肿块时,应高度怀疑生殖细胞瘤。     

颅内原发性生殖细胞瘤形态学及免疫组织化学的研究

对12例原发性生殖细胞瘤的组织进行了组织病理学观察,并用免疫组织化学 ABC 法酶标生殖细胞瘤中的妊娠特异β_1糖蛋白(SP_1),人胎盘催乳素(hPL),人绒毛膜促性腺激素(hCG)。结果表明在部分瘤组织中存有一种大细胞。在免疫组化标本中,含 SP_1阳性细胞的瘤组织有6例,占50%,含hCG 阳性细胞的瘤组织有3例,占25%(这3例 SP_1也呈阳性)。含 hPL 阳性细胞的瘤组织有3例,占25%(这3例 SP_1,hCG 均呈阳性)。这些免疫组织化学反应阳性的细胞均存在于“单核巨细胞”中,因此,证明了原发性生殖细胞瘤有分泌 SP_1、hCG、hPL 的功能,并推测瘤组织中的单核巨细胞可能来源于绒毛组织,我们称这些细胞为绒毛外滋养层细胞。     

鞍区生殖细胞瘤CT、MRI表现

目的探讨鞍区生殖细胞瘤的CT和MRI表现.方法选择过去10年经病理或临床证实的13例鞍区生殖细胞瘤患者作为研究对象,回顾性分析其治疗前CT和MR图像.结果 13例患者均表现为垂体柄增粗达16 mm以上和垂体后叶正常短T1高信号消失,其中12例有中枢性尿崩症.MR图像上10例肿瘤呈等T1信号,但在T2WI上信号表现为多样性.肿瘤囊变6例,其中5例可见肿瘤延伸入第三脑室.CT平扫图像显示所有肿瘤均无钙化,11例肿瘤实体部分表现为高密度.结论鞍区生殖细胞瘤的影像学特征表现为:CT平扫呈高密度,钙化少见;MRI为垂体柄增粗,垂体后叶短T1高信号消失.     

彩色多普勒超声在睾丸生殖细胞瘤诊断中的价值

目的探讨高频彩色多普勒超声在睾丸生殖细胞瘤临床诊断中的应用价值。方法回顾性分析33例睾丸生殖细胞瘤患者的二维声像图表现,并结合相关临床表现及血清甲胎蛋白(αFP)和人绒毛膜促性腺激素(βhCG)值进行综合分析。所有病例均经手术后病理证实。结果术后病理诊断精原细胞瘤13例、胚胎癌4例、畸胎瘤7例、卵黄囊瘤4例、混合性生殖细胞瘤5例。各类肿瘤其二维超声各具一定特征,其中所检测到的最小肿瘤大小为0.4cm×0.6cm。本组睾丸生殖细胞瘤肿块内动脉血流收缩期峰值流速[(25±11)cm/s]明显高于正常人睾丸动脉[(8.97±2.74)cm/s],而其阻力指数(0.58±0.09)与正常参考值(0.54±0.09)有较大的交叉。高频彩色多普勒超声诊断睾丸生殖细胞瘤的符合率达97%(32/33)。本组10例睾丸生殖细胞瘤患者αFP升高,2例βhCG升高,3例αFP和βhCG均升高。结论高频彩色多普勒超声对睾丸生殖细胞瘤有很高的诊断价值,且能早期发现肿瘤;结合相关临床表现及血清αFP、βhCG等资料,可进一步为睾丸生殖细胞瘤的诊断、治疗及预后判断等提供可靠的信息。