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1. Regueiro CA: [Treatment of intracranial germ cell tumours and other tumours of the pineal region]. Neurocirugia (Astur); 2003 Apr;14(2):127-39
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  • [Title] [Treatment of intracranial germ cell tumours and other tumours of the pineal region].
  • [Transliterated title] Tratamiento de los tumores germinales intracraneales y otros tumores de la región pineal.
  • The management of patients with central nervous system germ-cell tumours is evolving, and a definitive standard has not been achieved.
  • Various prospective trials evaluated the results of combinations of chemotherapy and reduced dose and/or volume radiotherapy.
  • The survival rates of combined treatment approaches were similar to the rates achieved with craniospinal radiotherapy alone.
  • Additional studies are necessary to determine the appropriate radiotherapy volumes and the role of combined treatments.
  • Chemotherapy alone results in high relapse rates and can not be recommended.
  • Non-germinoma germ cell tumours are a heterogeneous group of tumours that includes very aggressive tumours such as mixed and pure choriocarcinomas, yolk sac tumours, and embryonal carcinomas; and tumours with intermediate aggressiveness such as mixed tumours with germinoma and teratoma, immature teratomas and teratomas with malignant transformation.
  • Both radiotherapy alone and chemotherapy alone result in quite low rates of tumour control and current treatment approaches include chemotherapy and radiotherapy, with surgical removal of the tumour in some patients.
  • Current treatment approaches for pineoblastomas include surgery, chemotherapy, and craniospinal irradiation with a local boost.
  • Chemotherapy alone was used to delay irradiation in infants with very little success.
  • [MeSH-major] Brain Neoplasms / radiotherapy. Brain Neoplasms / surgery. Neoplasms, Germ Cell and Embryonal / radiotherapy. Neoplasms, Germ Cell and Embryonal / surgery. Pineal Gland / radiation effects. Pineal Gland / surgery. Pinealoma / radiotherapy. Pinealoma / surgery

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  • (PMID = 12754642.001).
  • [ISSN] 1130-1473
  • [Journal-full-title] Neurocirugía (Asturias, Spain)
  • [ISO-abbreviation] Neurocirugia (Astur)
  • [Language] spa
  • [Publication-type] English Abstract; Journal Article; Review
  • [Publication-country] Spain
  • [Number-of-references] 98
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2. Beck H, Moriyama E: Transverse sinus-tentorium splitting approach for pineal region tumors--case report. Neurol Med Chir (Tokyo); 2001 Apr;41(4):217-21
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  • [Title] Transverse sinus-tentorium splitting approach for pineal region tumors--case report.
  • A 15-year-old boy with a large pineal region mass was admitted to our institute.
  • The tumor tissue was completely resected, and no operative complication other than transient vertical gaze paresis was noted.
  • The histological diagnosis was mixed germ cell tumor composed of mature and immature teratoma, germinoma, and embryonal carcinoma.
  • After three courses of chemotherapy, the patient underwent external irradiation.
  • This approach enables safer and more extensive tumor removal for large pineal region tumors.
  • [MeSH-major] Brain Neoplasms / surgery. Neoplasms, Germ Cell and Embryonal / surgery. Neurosurgical Procedures / methods. Pineal Gland / pathology. Pineal Gland / surgery
  • [MeSH-minor] Adolescent. Brain / pathology. Brain / surgery. Humans. Male. Treatment Outcome

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  • (PMID = 11381683.001).
  • [ISSN] 0470-8105
  • [Journal-full-title] Neurologia medico-chirurgica
  • [ISO-abbreviation] Neurol. Med. Chir. (Tokyo)
  • [Language] eng
  • [Publication-type] Case Reports; Journal Article
  • [Publication-country] Japan
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3. Amendola BE, Wolf A, Coy SR, Amendola MA, Eber D: Pineal tumors: analysis of treatment results in 20 patients. J Neurosurg; 2005 Jan;102(s_supplement):175-179

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  • [Title] Pineal tumors: analysis of treatment results in 20 patients.
  • OBJECT: The authors evaluate their results when using gamma knife surgery (GKS) in the management of patients with tumors in the pineal region.
  • METHODS: This is a retrospective clinical evaluation of 20 patients with primary tumors of the pineal region treated with GKS from November 1994 through August 2003.
  • There were 13 germ cell tumors, two pineoblastomas, two low-grade gliomas, one primitive neuroectodermal tumor, one teratoma, and one pineocytoma.
  • The median margin dose was 11 Gy (range 8-20 Gy).
  • Five patients received sequential systemic chemotherapy and four underwent adjuvant conventional radiation therapy.
  • CONCLUSIONS: This initial experience suggests that GKS is a valuable treatment modality for the management of pineal region tumors.
  • This technique offers excellent local tumor control and minimal patient morbidity, allowing for immediate use of systemic chemotherapy and/or conventional radiation if indicated.

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  • (PMID = 28306462.001).
  • [ISSN] 1933-0693
  • [Journal-full-title] Journal of neurosurgery
  • [ISO-abbreviation] J. Neurosurg.
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] United States
  • [Keywords] NOTNLM ; gamma knife surgery / glioma / pineal tumor / pineoblastoma / pineocytoma / primitive neuroectodermal tumor / teratoma
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4. Nakamura H, Takeshima H, Makino K, Kuratsu J: Evaluation of residual tissues after adjuvant therapy in germ cell tumors. Pediatr Neurosurg; 2007;43(2):82-91
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  • [Title] Evaluation of residual tissues after adjuvant therapy in germ cell tumors.
  • OBJECTIVE: Germ cell tumors are the tumors sensitive for adjuvant therapy such as radiotherapy and chemotherapy.
  • We evaluated the pathological findings of these heterogeneous tumors to determine the persistence of residual viable tumor cells after adjuvant therapy.
  • RESULTS: Post-treatment, 3 group 1 and 12 group 2 patients manifested residual tumors.
  • The pathological diagnosis in group 1 patients was mature teratoma, pineal cyst, and fibrous tissue with calcification; in group 2 it was yolk sac tumor (n = 1), immature teratoma (n = 3), mature teratoma (n = 4), and necrosis or fibrous tissue (n = 4).
  • While no group 1 patients manifested tumor cells, MIB-1-positive viable tumor cells were present in resected tissues from one-third of the group 2 patients (3 immature teratomas and 1 yolk sac tumor).
  • CONCLUSION: The absence of viable tumor cells in residual tissue indicates that the combination of cisplatin-based chemo- and radiotherapy was effective in our germinoma patients.
  • On the other hand, in patients with NGMGCTs, these cells persisted despite this combination therapy.
  • [MeSH-major] Brain Neoplasms / diagnosis. Brain Neoplasms / therapy. Neoplasm, Residual / diagnosis. Neoplasms, Germ Cell and Embryonal / diagnosis. Neoplasms, Germ Cell and Embryonal / therapy
  • [MeSH-minor] Adolescent. Adult. Antineoplastic Protocols. Biopsy. Chemotherapy, Adjuvant. Child. Child, Preschool. Combined Modality Therapy. Female. Follow-Up Studies. Giant Cells / pathology. Humans. Magnetic Resonance Imaging. Male. Middle Aged. Radiotherapy, Adjuvant. Survival Rate. Trophoblasts / pathology

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  • [Copyright] Copyright (c) 2007 S. Karger AG, Basel.
  • (PMID = 17337917.001).
  • [ISSN] 1016-2291
  • [Journal-full-title] Pediatric neurosurgery
  • [ISO-abbreviation] Pediatr Neurosurg
  • [Language] eng
  • [Publication-type] Journal Article; Research Support, Non-U.S. Gov't
  • [Publication-country] Switzerland
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5. Hanna A, Edan C, Heresbach N, Ben Hassel M, Guegan Y: [Expanding mature pineal teratoma syndrome. Case report]. Neurochirurgie; 2000 Dec;46(6):568-572
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  • [Title] [Expanding mature pineal teratoma syndrome. Case report].
  • We present a case of growing teratoma syndrome of the pineal region.
  • CT scan showed a pineal region tumor with obstructive hydrocephalus.
  • After three cycles of chemotherapy, MRI showed an important increase in tumor size with morphologic modifications.
  • Surgical resection was performed and histological examination of the whole specimen showed mature teratoma.
  • Growing teratoma syndrome is a mixed germ cell tumor with a secreting portion that responds to chemotherapy and a non secreting portion of mature teratoma that continues to grow under chemotherapy.
  • The treatment should include chemotherapy for the malignant secreting portion and surgery for the mature teratoma.
  • [MeSH-major] Pinealoma / pathology. Teratoma / pathology
  • [MeSH-minor] Adolescent. Antineoplastic Combined Chemotherapy Protocols / therapeutic use. Biomarkers, Tumor / analysis. Cerebrospinal Fluid Shunts. Chorionic Gonadotropin / blood. Chorionic Gonadotropin / cerebrospinal fluid. Chorionic Gonadotropin / secretion. Combined Modality Therapy. Diagnosis, Differential. Diplopia / etiology. Etoposide / administration & dosage. Germinoma / diagnosis. Humans. Ifosfamide / administration & dosage. Intracranial Hypertension / etiology. Magnetic Resonance Imaging. Male. Neoplasm Invasiveness. Neoplasm Proteins / blood. Neoplasm Proteins / cerebrospinal fluid. Neoplasm Proteins / secretion. Radiotherapy, Adjuvant. Remission Induction. Thalamus / pathology

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  • (PMID = 11148410.001).
  • [ISSN] 0028-3770
  • [Journal-full-title] Neuro-Chirurgie
  • [ISO-abbreviation] Neurochirurgie
  • [Language] fre
  • [Publication-type] Case Reports; English Abstract; Journal Article
  • [Publication-country] France
  • [Chemical-registry-number] 0 / Biomarkers, Tumor; 0 / Chorionic Gonadotropin; 0 / Neoplasm Proteins; 6PLQ3CP4P3 / Etoposide; UM20QQM95Y / Ifosfamide
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6. Dolendo MC, Lin TP, Tat OH, Chong QT, Timothy LK: Parkinsonism as an unusual presenting symptom of pineal gland teratoma. Pediatr Neurol; 2003 Apr;28(4):310-2
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  • [Title] Parkinsonism as an unusual presenting symptom of pineal gland teratoma.
  • We report a case of a 14-year-old Chinese boy with immature teratoma of the pineal gland who manifested with parkinsonism.
  • Diagnostic evaluation revealed hydrocephalus and an immature teratoma of the pineal gland extending to the thalamus.
  • An urgent ventriculoperitoneal shunt was inserted, and chemotherapy was given to reduce the tumor size.
  • Magnetic resonance imaging (MRI) revealed a small enhancing lesion in the pineal region and progressive hydrocephalus on serial studies.
  • Features consistent with the growing teratoma syndrome were noted during this period.
  • These were progressive pineal gland tumor enlargement documented on MRI without increase in previously elevated alpha-fetoprotein levels.
  • Secondary parkinsonism is a rare presentation of pineal gland tumors and has not been reported in association with the growing teratoma syndrome.
  • [MeSH-minor] Adolescent. Combined Modality Therapy. Disease Progression. Equipment Failure. Follow-Up Studies. Humans. Hydrocephalus / diagnosis. Hydrocephalus / etiology. Image Enhancement. Magnetic Resonance Imaging. Male. Neoplasm Recurrence, Local / diagnosis. Neoplasm Recurrence, Local / therapy. Ventriculoperitoneal Shunt

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  • (PMID = 12849888.001).
  • [ISSN] 0887-8994
  • [Journal-full-title] Pediatric neurology
  • [ISO-abbreviation] Pediatr. Neurol.
  • [Language] eng
  • [Publication-type] Case Reports; Journal Article
  • [Publication-country] United States
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7. Nogueira K, Liberman B, Pimentel-Filho FR, Goldman J, Silva ME, Vieira JO, Buratini JA, Cukiert A: hCG-secreting pineal teratoma causing precocious puberty: report of two patients and review of the literature. J Pediatr Endocrinol Metab; 2002 Sep-Oct;15(8):1195-201
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  • [Title] hCG-secreting pineal teratoma causing precocious puberty: report of two patients and review of the literature.
  • Two boys are described with precocious puberty (PP) due to pineal immature teratoma associated with choriocarcinoma.
  • Magnetic resonance imaging (MRI) showed a 3.0 cm pineal mass.
  • He was initially submitted to a trial with radiotherapy, followed by radical surgical resection, stereotactic radiotherapy and chemotherapy.
  • MRI showed a 1.0 cm pineal mass.
  • He was submitted to radical surgical resection (which caused normalization of levels of markers) and prophylactic chemotherapy.
  • An extensive review of the literature corroborates the idea that this last treatment paradigm (surgery and chemotherapy) probably represents the best treatment regimen for these patients.
  • [MeSH-major] Chorionic Gonadotropin / secretion. Pinealoma / complications. Puberty, Precocious / etiology. Teratoma / complications
  • [MeSH-minor] Child. Choriocarcinoma / complications. Choriocarcinoma / therapy. Fatal Outcome. Humans. Male

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  • (PMID = 12387519.001).
  • [ISSN] 0334-018X
  • [Journal-full-title] Journal of pediatric endocrinology & metabolism : JPEM
  • [ISO-abbreviation] J. Pediatr. Endocrinol. Metab.
  • [Language] eng
  • [Publication-type] Case Reports; Journal Article; Review
  • [Publication-country] England
  • [Chemical-registry-number] 0 / Chorionic Gonadotropin
  • [Number-of-references] 38
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8. Sugimoto K, Nakahara I, Nishikawa M: Bilateral metachronous germinoma of the basal ganglia occurring long after total removal of a mature pineal teratoma: case report. Neurosurgery; 2002 Mar;50(3):613-6; discussion 616-7
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  • [Title] Bilateral metachronous germinoma of the basal ganglia occurring long after total removal of a mature pineal teratoma: case report.
  • OBJECTIVE AND IMPORTANCE: We report the extremely rare occurrence of a second germ cell tumor at a different site and with different histological types long after total removal of a mature pineal teratoma.
  • Neuroradiological studies revealed a tumor in the pineal region.
  • Histologically, the tumor proved to be a mature teratoma.
  • The patient received no adjuvant therapy and was followed in the outpatient clinic.
  • The patient received three cycles of combination chemotherapy consisting of carboplatin and etoposide with radiotherapy.
  • After the second course of chemotherapy, magnetic resonance imaging studies revealed no evidence of the tumor.
  • CONCLUSION: The second tumor was considered to be a de novo metachronous neoplasm rather than a recurrence of the original mature teratoma.
  • We think that if primordial germ cell groups exist along the midline of the brain, more than two primordial germ cell groups could give rise to metachronous neoplasms at different sites and with different histological types.
  • [MeSH-major] Basal Ganglia Diseases / surgery. Brain Neoplasms / surgery. Germinoma / surgery. Neoplasms, Second Primary. Pineal Gland / surgery. Teratoma / surgery
  • [MeSH-minor] Antineoplastic Agents / administration & dosage. Antineoplastic Agents, Phytogenic / administration & dosage. Antineoplastic Combined Chemotherapy Protocols / therapeutic use. Carboplatin / administration & dosage. Child. Combined Modality Therapy. Etoposide / administration & dosage. Humans. Magnetic Resonance Imaging. Male

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  • (PMID = 11841731.001).
  • [ISSN] 0148-396X
  • [Journal-full-title] Neurosurgery
  • [ISO-abbreviation] Neurosurgery
  • [Language] eng
  • [Publication-type] Case Reports; Journal Article; Review
  • [Publication-country] United States
  • [Chemical-registry-number] 0 / Antineoplastic Agents; 0 / Antineoplastic Agents, Phytogenic; 6PLQ3CP4P3 / Etoposide; BG3F62OND5 / Carboplatin
  • [Number-of-references] 11
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9. Iwamuro Y, Seo S, Hirose Y, Jito J, Shirahata M, Tokime T, Hosotani K, Tokuriki Y: Intrathecal and intraperitoneal germinomas occurring 20 years after total removal of a pineal teratoma. Case report. J Neurosurg; 2002 Feb;96(2):364-7
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  • [Title] Intrathecal and intraperitoneal germinomas occurring 20 years after total removal of a pineal teratoma. Case report.
  • Computerized tomography (CT) scans revealed a pineal mass lesion and hydrocephalus.
  • Histological investigation of a surgical specimen revealed that it was a teratoma.
  • The patient received systemic chemotherapy, and the tumor disappeared; however, 2 years after the chemotherapy, MR imaging demonstrated a right lateral ventricular mass.
  • Three years after the chemotherapy, CT scanning revealed suprasellar and right lateral ventricular tumor recurrences, for which the patient received irradiation and chemotherapy.
  • The patient received systemic chemotherapy and the tumor disappeared completely.
  • [MeSH-major] Abdominal Neoplasms / pathology. Abdominal Neoplasms / therapy. Brain Neoplasms / pathology. Brain Neoplasms / therapy. Germinoma / pathology. Germinoma / therapy. Neoplasms, Second Primary / pathology. Neoplasms, Second Primary / therapy. Pineal Gland / pathology. Teratoma / pathology. Teratoma / therapy
  • [MeSH-minor] Adolescent. Adult. Child. Humans. Male. Time Factors. Ventriculoperitoneal Shunt

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  • (PMID = 11838813.001).
  • [ISSN] 0022-3085
  • [Journal-full-title] Journal of neurosurgery
  • [ISO-abbreviation] J. Neurosurg.
  • [Language] eng
  • [Publication-type] Case Reports; Journal Article
  • [Publication-country] United States
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10. Friedman JA, Lynch JJ, Buckner JC, Scheithauer BW, Raffel C: Management of malignant pineal germ cell tumors with residual mature teratoma. Neurosurgery; 2001 Mar;48(3):518-22; discussion 522-3
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  • [Title] Management of malignant pineal germ cell tumors with residual mature teratoma.
  • OBJECTIVE: The treatment of intracranial mixed germ cell tumors presents a unique challenge, since eradication of malignant tumor by radiation and/or chemotherapy may spare the benign tumor component.
  • We reviewed our surgical experience with residual malignant pineal germ cell tumors after neoadjuvant therapy.
  • METHODS: Between 1987 and 1997, 16 patients with malignant intracranial germ cell tumors were treated at the Mayo Clinic with a protocol of neoadjuvant chemotherapy and radiation therapy.
  • After the diagnosis was confirmed by histopathological examination, all patients were treated with four cycles of etoposide and cisplatin as well as external beam radiation therapy (range, 3030-5940 cGy).
  • Six patients had an incomplete response to therapy, as demonstrated by observation of residual tumor on magnetic resonance imaging scans.
  • Initial pathology in these six patients was germinoma in four and combinations of yolk sac tumor, embryonal carcinoma, malignant teratoma, and germinoma in two.
  • Two patients had synchronous pineal and suprasellar tumors, with leptomeningeal dissemination.
  • RESULTS: All patients with residual pineal tumors underwent surgical resection via an infratentorial, supracerebellar approach.
  • Pathological examination revealed mature teratoma in five patients and amorphous debris in one patient.
  • CONCLUSION: Residual pineal tumor occurring after treatment of malignant intracranial germ cell tumor with neoadjuvant therapy is likely to be mature teratoma.
  • [MeSH-major] Brain Neoplasms / surgery. Germinoma / surgery. Neoplasms, Multiple Primary / surgery. Pineal Gland. Teratoma / surgery
  • [MeSH-minor] Adolescent. Adult. Algorithms. Child. Combined Modality Therapy. Female. Follow-Up Studies. Humans. Male. Neoplasm, Residual


11. Utsuki S, Oka H, Sagiuchi T, Shimizu S, Suzuki S, Fujii K: Malignant transformation of intracranial mature teratoma to yolk sac tumor after late relapse. Case report. J Neurosurg; 2007 Jun;106(6):1067-9
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  • [Title] Malignant transformation of intracranial mature teratoma to yolk sac tumor after late relapse. Case report.
  • The recurrence of intracranial mature teratomas as germ cell tumors of different histological types is rarely reported.
  • The authors describe the first case of the malignant transformation of an intracranial mature teratoma into a yolk sac tumor in a 16-year-old boy who presented with a 1-month history of anorexia and somnolence.
  • Seven years prior to this presentation, the boy had undergone surgery for extirpation of a mature pineal teratoma.
  • Computed tomography images obtained at his second presentation revealed a homogeneously enhanced mass within the third ventricle.
  • After resection, the patient underwent radiation therapy followed by chemotherapy with cisplatin and etoposide but died of tumor progression 15 months after his second hospitalization.
  • [MeSH-major] Brain Neoplasms / pathology. Endodermal Sinus Tumor / pathology. Endodermal Sinus Tumor / surgery. Teratoma / pathology. Teratoma / surgery
  • [MeSH-minor] Child. Combined Modality Therapy. Fatal Outcome. Humans. Magnetic Resonance Imaging. Male. Neoplasm Recurrence, Local. Pinealoma / pathology. Pinealoma / surgery. Tomography, X-Ray Computed

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  • (PMID = 17564180.001).
  • [ISSN] 0022-3085
  • [Journal-full-title] Journal of neurosurgery
  • [ISO-abbreviation] J. Neurosurg.
  • [Language] eng
  • [Publication-type] Case Reports; Journal Article
  • [Publication-country] United States
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12. Pitskhelauri DI, Konovalov AN, Azizian VN, Kornienko VN, Korshunov AG, Melikian AG, Loshakov VA, Serova NK: [Iatrogenic metastasis of pineal tumors]. Zh Vopr Neirokhir Im N N Burdenko; 2004 Oct-Dec;(4):28-33; discussion 33-4
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  • [Title] [Iatrogenic metastasis of pineal tumors].
  • [Transliterated title] Iatrogennoe metastazirovanie opukholeĭ pineal'noĭ oblasti.
  • Malignant pineal tumors (PT) tend to metastasize.
  • The sources of metastases were pineoblastoma (n = 1), malignant teratoma (n = 1), germinoma (n = 1), and malignant germ-cell tumor of unknown genesis (n = 1).
  • To prevent this complication due to high-grade PT, such as malignant germ-cell tumors and pineoblastomas, radiation of the whole brain, besides the sites of a tumor should be performed and, in some cases, in combination with chemotherapy.
  • [MeSH-minor] Adolescent. Child, Preschool. Gastrointestinal Neoplasms / pathology. Gastrointestinal Neoplasms / secondary. Humans. Male. Neoplasm Metastasis. Neoplasm Recurrence, Local. Pineal Gland. Postoperative Complications / pathology. Teratoma / pathology. Teratoma / secondary. Teratoma / surgery

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  • (PMID = 15724549.001).
  • [ISSN] 0042-8817
  • [Journal-full-title] Zhurnal voprosy neĭrokhirurgii imeni N. N. Burdenko
  • [ISO-abbreviation] Zh Vopr Neirokhir Im N N Burdenko
  • [Language] rus
  • [Publication-type] Case Reports; English Abstract; Journal Article
  • [Publication-country] Russia
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13. Kamoshima Y, Sawamura Y, Iwasaki M, Iwasaki Y, Sugiyama K: Metachronous mature teratoma in the corpus callosum occurring 12 years after a pineal germinoma. J Neurosurg; 2008 Jul;109(1):126-9
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  • [Title] Metachronous mature teratoma in the corpus callosum occurring 12 years after a pineal germinoma.
  • The authors report a metachronous germ cell tumor with different histological type occurring 12 years after resection of a pineal germinoma.
  • Histological examination of the original tumor revealed germinoma without any other component of germ cell tumor, and the patient underwent chemotherapy followed by 24 Gy of localized irradiation.
  • Two courses of chemotherapy were administered, but the tumor size remained stable.
  • The histological diagnosis was mature teratoma.
  • The second tumor was considered as a metachronous mature teratoma rather than a recurrence of the original germinoma.
  • [MeSH-major] Brain Neoplasms / pathology. Corpus Callosum. Neoplasms, Second Primary / pathology. Pineal Gland. Pinealoma / pathology. Teratoma / pathology
  • [MeSH-minor] Adult. Humans. Male. Time Factors

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  • (PMID = 18590442.001).
  • [ISSN] 0022-3085
  • [Journal-full-title] Journal of neurosurgery
  • [ISO-abbreviation] J. Neurosurg.
  • [Language] eng
  • [Publication-type] Case Reports; Journal Article
  • [Publication-country] United States
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14. Denaro L, Pluchinotta F, Faggin R, Manara R, Calderone M, Viscardi E, Gardiman M, Rossetto M, Perilongo G, d'Avella D: What's growing on? The growing teratoma syndrome. Acta Neurochir (Wien); 2010 Nov;152(11):1943-6
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  • [Title] What's growing on? The growing teratoma syndrome.
  • BACKGROUND: The growing teratoma syndrome (GTS) consists of a mature teratoma paradoxically enlarging during or after chemotherapy for malignant nongerminomatous germ cell tumors.
  • METHODS AND RESULTS: We report two cases of GTS occurring in association with NSGCT of the pineal gland.
  • CONCLUSIONS: When normalized tumor markers after chemotherapy are associated with imaging features of a growing mass, the hypothesis of GTS must be taken in consideration.
  • [MeSH-major] Antineoplastic Agents / adverse effects. Drug-Related Side Effects and Adverse Reactions. Neoplasms, Germ Cell and Embryonal / complications. Neoplasms, Germ Cell and Embryonal / drug therapy. Pinealoma / complications. Pinealoma / drug therapy. Teratoma / chemically induced
  • [MeSH-minor] Adolescent. Child, Preschool. Drug Therapy / methods. Humans. Male. Neoplasm Invasiveness / pathology. Neoplasm Invasiveness / physiopathology. Syndrome. Treatment Outcome

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  • (PMID = 20878531.001).
  • [ISSN] 0942-0940
  • [Journal-full-title] Acta neurochirurgica
  • [ISO-abbreviation] Acta Neurochir (Wien)
  • [Language] eng
  • [Publication-type] Case Reports; Journal Article; Research Support, Non-U.S. Gov't
  • [Publication-country] Austria
  • [Chemical-registry-number] 0 / Antineoplastic Agents
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15. Amendola BE, Wolf A, Coy SR, Amendola MA, Eber D: Pineal tumors: analysis of treatment results in 20 patients. J Neurosurg; 2005 Jan;102 Suppl:175-9

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  • [Title] Pineal tumors: analysis of treatment results in 20 patients.
  • OBJECT: The authors evaluate their results when using gamma knife surgery (GKS) in the management of patients with tumors in the pineal region.
  • METHODS: This is a retrospective clinical evaluation of 20 patients with primary tumors of the pineal region treated with GKS from November 1994 through August 2003.
  • There were 13 germ cell tumors, two pineoblastomas, two low-grade gliomas, one primitive neuroectodermal tumor, one teratoma, and one pineocytoma.
  • The median margin dose was 11 Gy (range 8-20 Gy).
  • Five patients received sequential systemic chemotherapy and four underwent adjuvant conventional radiation therapy.
  • CONCLUSIONS: This initial experience suggests that GKS is a valuable treatment modality for the management of pineal region tumors.
  • This technique offers excellent local tumor control and minimal patient morbidity, allowing for immediate use of systemic chemotherapy and/or conventional radiation if indicated.
  • [MeSH-minor] Adolescent. Adult. Aged. Child. Child, Preschool. Diagnosis, Differential. Female. Glioma / mortality. Glioma / pathology. Glioma / surgery. Humans. Hydrocephalus / pathology. Magnetic Resonance Imaging. Male. Middle Aged. Neuroectodermal Tumors, Primitive / mortality. Neuroectodermal Tumors, Primitive / pathology. Neuroectodermal Tumors, Primitive / surgery. Radiation Dosage. Retrospective Studies. Survival Rate. Teratoma / mortality. Teratoma / pathology. Teratoma / surgery

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  • (PMID = 15662805.001).
  • [ISSN] 0022-3085
  • [Journal-full-title] Journal of neurosurgery
  • [ISO-abbreviation] J. Neurosurg.
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] United States
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16. Nomura K: Epidemiology of germ cell tumors in Asia of pineal region tumor. J Neurooncol; 2001 Sep;54(3):211-7
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  • [Title] Epidemiology of germ cell tumors in Asia of pineal region tumor.
  • A higher incidence of pineal region tumors in Asian countries compared to Western countries has been reported.
  • In the Brain Tumor Registry of Japan (BTRJ), there were 38,273 primary brain tumors except those of unknown histology (1123 cases) registered in the period between 1984 and 1993, in which 807 pineal region tumors with 104 unknown histology were registered in BTRJ.
  • Of these pineal region tumors, germ cell tumors had the highest frequency, 70.3%, followed by pineal parenchymal tumors, 12.0%; pineocytoma in 7.8% and pineoblastoma in 4.2%.
  • Limited to germ cell tumors, germinoma was 68.0%, then teratoma including malignant teratoma, had the second high frequency, 14.7% in pineal region.
  • While data reported by Allaire et al. and Edwards et al. revealed that the incidence of germinoma was 88.6%, 52.4% of germ cell tumors in pineal region in France and in USA, respectively.
  • Although number of cases is very small, it is suggested that the percentage of germinoma in germ cell tumors in the pineal region might be almost the same in Western countries as in Asian countries, and the occurrence of germ cell tumors in the pineal region was much higher than those in Asia.
  • Age and gender distribution of pineal region tumors indicated that germ cell tumors and pineocytoma showed a high incidence in males and in children.
  • Most of malignant pineal region tumors other than germinomas showed poor prognosis, but recent progress in surgical techniques and effective chemotherapy will improve the prognosis.
  • [MeSH-major] Brain Neoplasms / epidemiology. Germinoma / epidemiology. Pineal Gland

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  • [Cites] J Neurosurg. 1969 Feb;30(2):146-9 [5780883.001]
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  • (PMID = 11767288.001).
  • [ISSN] 0167-594X
  • [Journal-full-title] Journal of neuro-oncology
  • [ISO-abbreviation] J. Neurooncol.
  • [Language] eng
  • [Publication-type] Journal Article; Research Support, Non-U.S. Gov't
  • [Publication-country] United States
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17. Moiyadi A, Jalali R, Kane SV: Intracranial growing teratoma syndrome following radiotherapy--an unusually fulminant course. Acta Neurochir (Wien); 2010 Jan;152(1):137-42
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  • [Title] Intracranial growing teratoma syndrome following radiotherapy--an unusually fulminant course.
  • INTRODUCTION: Residual radiologically progressive masses following multimodality treatment of malignant mixed intracranial germ cell tumors are described.
  • Often these enlarge, and this is called the growing teratoma syndrome.
  • RESULTS: A review of the scanty tissue was suggestive of a pineal parenchymal tumor, and hence radiation was planned.
  • After just ten fractions, he developed rapid neurological deterioration.
  • Histology revealed a purely mature teratoma.
  • CONCLUSION: Though a growing teratoma syndrome has been described following chemotherapy, no such report while on radiation exists.
  • [MeSH-major] Brain Neoplasms / etiology. Neoplasms, Radiation-Induced. Pinealoma / radiotherapy. Teratoma / etiology
  • [MeSH-minor] Child, Preschool. Fatal Outcome. Humans. Magnetic Resonance Imaging. Male. Neurosurgical Procedures. Tomography, X-Ray Computed

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  • (PMID = 19404574.001).
  • [ISSN] 0942-0940
  • [Journal-full-title] Acta neurochirurgica
  • [ISO-abbreviation] Acta Neurochir (Wien)
  • [Language] eng
  • [Publication-type] Case Reports; Journal Article; Review
  • [Publication-country] Austria
  • [Number-of-references] 23
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18. Fischer B, Palkovic S, Wassmann H: Treatment strategy of pineal tumors in consideration of their pathomorphology. Bratisl Lek Listy; 2004;105(3):95-100

  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] Treatment strategy of pineal tumors in consideration of their pathomorphology.
  • BACKGROUND: Tumors of the pineal gland are rare pathology.
  • This paper reports on therapeutical considerations of histologically heterogeneous pineal tumors in a group of 15 patients and is presenting a special case of neuroaxial seeding.
  • METHODS: Surgery and/or additional therapeutic procedures were performed in 13 of our 15 patients ("youngster" and "adults") in respect of pathomorphology.
  • Details are reported concerning a 52-year-old man suffering from pineocytoma (WHO grade II), who underwent different kinds of therapy within 10 years follow-up.
  • Additional radio-/chemotherapy was used in a case of teratoma and pineocytoma/pineoblastoma.
  • CONCLUSION: Precise histopathological assessment of pineal tumors is essential to guide optimal modern therapy modalities in order to assure a local tumor control. (Fig. 3, Ref. 18.).

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  • (PMID = 15253526.001).
  • [ISSN] 0006-9248
  • [Journal-full-title] Bratislavské lekárske listy
  • [ISO-abbreviation] Bratisl Lek Listy
  • [Language] eng
  • [Publication-type] Case Reports; Journal Article
  • [Publication-country] Slovakia
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19. Tamaki N, Yin D: Therapeutic strategies and surgical results for pineal region tumours. J Clin Neurosci; 2000 Mar;7(2):125-8
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] Therapeutic strategies and surgical results for pineal region tumours.
  • Until recently, surgery for pineal region tumours has met with poor results.
  • Over 26 years we treated 36 patients including: 24 with germinoma; four, teratoma; three, pineal cyst; and one each, embryonal carcinoma, choriocarcinoma, pineocytoma, pineoblastoma and metastasis.
  • All 24 germinomas responded to radiotherapy, as did one case each for teratoma, pineoblastoma, and choriocarcinoma.
  • Current operative techniques allow safe, effective removal of pineal region tumours.
  • [MeSH-major] Brain Neoplasms / therapy. Pineal Gland. Pinealoma / therapy
  • [MeSH-minor] Adolescent. Adult. Aged. Child. Child, Preschool. Drug Therapy. Female. Gonadotropins / cerebrospinal fluid. Humans. Infant. Male. Microsurgery / methods. Middle Aged. Neurosurgical Procedures / methods. Radiotherapy. Retrospective Studies. Treatment Outcome. alpha-Fetoproteins / cerebrospinal fluid

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  • [Copyright] Copyright 2000 Harcourt Publishers Ltd.
  • (PMID = 10844797.001).
  • [ISSN] 0967-5868
  • [Journal-full-title] Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia
  • [ISO-abbreviation] J Clin Neurosci
  • [Language] eng
  • [Publication-type] Clinical Trial; Comparative Study; Journal Article
  • [Publication-country] Scotland
  • [Chemical-registry-number] 0 / Gonadotropins; 0 / alpha-Fetoproteins
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20. Peltier J, Vinchon M, Baroncini M, Kerdraon O, Dhellemmes P: Bifocal mixed germ-cell tumor with growing teratoma syndrome and metachronous mature metastases: case report. J Neurooncol; 2008 Oct;90(1):111-5
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] Bifocal mixed germ-cell tumor with growing teratoma syndrome and metachronous mature metastases: case report.
  • The authors report the case of a 16-year-old male who presented with a bifocal diencephalic tumor arising both in the neurohypophysis and the pineal region with hydrocephalus.
  • MRI revealed an increase of the neoplasm during chemotherapy with recurrent obstructive hydrocephalus.
  • The final histopathological analysis demonstrated an immature teratoma.
  • Subsequently, this patient developed metachronous cystic metastases in the cerebello-pontine angles, which were resected and identified as mature teratoma, then we observed a lesion of the brachium conjunctivum which stayed stable after 29 consecutive months.
  • To our knowledge, this is the fifth case of the growing teratoma syndrome located in the brain but the first case with simultaneously bifocal location and infratentorial disseminated metastasis.
  • Obviously surgical removal is the treatment of reference for teratomas.
  • Metastases of teratoma can be mature and may be amenable to surgery with a favorable outcome.
  • Curiously, teratomas are able to grow during the first weeks of chemotherapy while serum markers remain normal.
  • This situation was originally described and designed as "the growing teratoma syndroma" (GTS) in primary testis tumors by Logothetis in 1982 [2].
  • [MeSH-major] Brain Neoplasms / pathology. Teratoma / secondary
  • [MeSH-minor] Adolescent. Antineoplastic Agents / therapeutic use. Combined Modality Therapy. Humans. Magnetic Resonance Imaging. Male. Neurosurgical Procedures. Pineal Gland / pathology. Pineal Gland / physiopathology

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  • [CommentIn] J Neurooncol. 2009 Sep;94(3):449-50 [19347253.001]
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  • (PMID = 18574668.001).
  • [ISSN] 0167-594X
  • [Journal-full-title] Journal of neuro-oncology
  • [ISO-abbreviation] J. Neurooncol.
  • [Language] eng
  • [Publication-type] Case Reports; Journal Article
  • [Publication-country] United States
  • [Chemical-registry-number] 0 / Antineoplastic Agents
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21. Kanamori M, Kumabe T, Tominaga T: Is histological diagnosis necessary to start treatment for germ cell tumours in the pineal region? J Clin Neurosci; 2008 Sep;15(9):978-87
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] Is histological diagnosis necessary to start treatment for germ cell tumours in the pineal region?
  • The significance of histological diagnosis was retrospectively investigated in the treatment of 79 consecutive patients with pineal region tumours.
  • Forty-one patients were treated under a clinical diagnosis of pineal germ cell tumour using neoadjuvant chemotherapy and radiation therapy without histological verification.
  • Most cases of pineal germ cell tumour could be identified on the basis of clinical findings only, and could be treated appropriately using neoadjuvant chemotherapy and radiation therapy without histological diagnosis.
  • [MeSH-major] Neoplasms, Germ Cell and Embryonal / diagnosis. Neoplasms, Germ Cell and Embryonal / therapy. Pineal Gland / pathology. Pinealoma / diagnosis. Pinealoma / therapy
  • [MeSH-minor] Adolescent. Adult. Aged. Antineoplastic Combined Chemotherapy Protocols / therapeutic use. Antineoplastic Protocols / standards. Biomarkers, Tumor / analysis. Child. Child, Preschool. Decision Support Techniques. Female. Humans. Infant. Male. Middle Aged. Neurosurgical Procedures. Predictive Value of Tests. Radiotherapy / methods. Retrospective Studies. Teratoma / diagnosis. Teratoma / metabolism. Teratoma / therapy. Treatment Outcome

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  • (PMID = 18617412.001).
  • [ISSN] 0967-5868
  • [Journal-full-title] Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia
  • [ISO-abbreviation] J Clin Neurosci
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] Scotland
  • [Chemical-registry-number] 0 / Biomarkers, Tumor
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22. Oi S, Shibata M, Tominaga J, Honda Y, Shinoda M, Takei F, Tsugane R, Matsuzawa K, Sato O: Efficacy of neuroendoscopic procedures in minimally invasive preferential management of pineal region tumors: a prospective study. J Neurosurg; 2000 Aug;93(2):245-53
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] Efficacy of neuroendoscopic procedures in minimally invasive preferential management of pineal region tumors: a prospective study.
  • OBJECT: This prospective study is based on a consecutive series of 20 patients with pineal region tumors who underwent minimally invasive preferential management.
  • The purpose of this report is to discuss the role of neuroendoscopic procedures in the management of pineal region tumors.
  • METHODS: If the tumor markers alpha-fetoprotein and human chorionic gonadotropin were not detected in serum and there was significant ventricular dilation visualized on neuroimages, neuroendoscopic surgery was first applied for tumor debulking with tissue diagnosis and gross morphological analysis of the tumor and the intraventricular structures, followed by third ventriculostomy.
  • For treatment of germinomas and pineoblastomas, if no tumor dissemination was confirmed by pre-, intra-, or postoperative findings, stereotactic radiotherapy or radiosurgery was performed after one course of chemotherapy with the ICE regimen (isofomid, cisplatin, and etoposide) and followed by two additional courses of chemotherapy.
  • For treatment of malignant germ cell tumors, after extensive surgery, adjuvant chemotherapy with the ICE regimen was performed in three courses in all cases.
  • For treatment of teratomatous and neuroectodermal tumors other than pineoblastomas, extensive surgical removal was performed.
  • As for adjuvant therapy, if the tumor was a low-grade glioma or if the patient was younger than 5 years of age, postoperative treatment did not include radiotherapy.
  • If the tumor was a malignant teratoma or high-grade glioma, conventional focal radiotherapy was performed, followed by chemotherapy with ICE for 1 year.
  • Neuroendoscopic biopsy with tumor debulking offered enough material for tissue diagnosis, including immunohistochemical analysis and, in one case, revealed evidence of tumor dissemination undetectable on neuroimaging.
  • Favorable therapeutic outcomes were obtained in all cases of germinoma and pineoblastoma, with follow-up periods ranging from 24 months to 6.5 years.
  • CONCLUSIONS: Our minimally invasive preferential regimen clarified the precise indication for neuroendoscopic procedures, and the majority of our patients with dilated ventricles and no evidence of tumor markers were treated satisfactorily with effective neuroendoscopic procedures as the initial procedure, avoiding unnecessary craniotomy and radiotherapy and promising excellent therapeutic outcomes.
  • The treatment for malignant pineal region tumors remains a subject for further study.
  • [MeSH-major] Brain Neoplasms / surgery. Endoscopy. Minimally Invasive Surgical Procedures. Pineal Gland / surgery. Pinealoma / surgery. Radiosurgery
  • [MeSH-minor] Adolescent. Adult. Aged. Biomarkers, Tumor / analysis. Chemotherapy, Adjuvant. Child. Female. Glioma / pathology. Glioma / surgery. Humans. Male. Middle Aged. Neoplasm Staging. Prospective Studies. Radiotherapy, Adjuvant. Risk Factors. Treatment Outcome

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  • (PMID = 10930010.001).
  • [ISSN] 0022-3085
  • [Journal-full-title] Journal of neurosurgery
  • [ISO-abbreviation] J. Neurosurg.
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] UNITED STATES
  • [Chemical-registry-number] 0 / Biomarkers, Tumor
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23. Kumabe T, Kusaka Y, Jokura H, Ikeda H, Shirane R, Yoshimoto T: [Recurrence of intracranial germinoma initially treated with chemotherapy only]. No Shinkei Geka; 2002 Sep;30(9):935-42
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] [Recurrence of intracranial germinoma initially treated with chemotherapy only].
  • Eight consecutive patients with intracranial germinoma underwent combination chemotherapy with BEP (bleomycin, etoposide, and cisplatin) or PE (cisplatin and etoposide) without irradiation between 1996 and 1997.
  • These 7 patients obtained complete response (CR) after treatment with chemotherapy only.
  • The diagnosis of pure germinoma was based on neuroradiographic appearances and the normal levels of tumor markers in patients with suprasellar and pineal-region germ cell tumors.
  • Although all patients obtained CR, 5 patients relapsed at a mean period of 19 months after the initial therapy.
  • Additional chemotherapy and total ventricle irradiation (24 Gy) achieved CR, but delayed seeding in the optic nerves outside the irradiated field was detected.
  • Another patient obtained CR after PE therapy, but there was not histological verification.
  • However, 35 months after the initial therapy, surgical extirpation of the recurrent tumor revealed immature teratoma.
  • One patient refused treatment for recurrence at the initial tumor site and died 42 months after the initial treatment.
  • Adequate initial therapy is absolutely essential for the treatment of intracranial germinoma.
  • The chemotherapy regimens in use today cannot be recommended as initial therapy without irradiation because of the high recurrence rates.
  • [MeSH-major] Brain Neoplasms / drug therapy. Germinoma / drug therapy. Neoplasm Recurrence, Local
  • [MeSH-minor] Adolescent. Adult. Antineoplastic Combined Chemotherapy Protocols / administration & dosage. Antineoplastic Combined Chemotherapy Protocols / therapeutic use. Bleomycin / administration & dosage. Child. Cisplatin / administration & dosage. Etoposide / administration & dosage. Fatal Outcome. Follow-Up Studies. Humans. Male. Radiotherapy, Adjuvant. Treatment Outcome

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  • (PMID = 12233091.001).
  • [ISSN] 0301-2603
  • [Journal-full-title] No shinkei geka. Neurological surgery
  • [ISO-abbreviation] No Shinkei Geka
  • [Language] jpn
  • [Publication-type] Case Reports; English Abstract; Journal Article
  • [Publication-country] Japan
  • [Chemical-registry-number] 11056-06-7 / Bleomycin; 6PLQ3CP4P3 / Etoposide; Q20Q21Q62J / Cisplatin; BEP protocol
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24. Kon H, Kumabe T, Jokura H, Shirane R: Recurrent intracranial germinoma outside the initial radiation field with progressive malignant transformation. Acta Neurochir (Wien); 2002 Jun;144(6):611-6
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  • A 19-year-old man with a pure germinoma in the pineal region was successfully treated with chemotherapy followed by 24 Gy local irradiation.
  • Near complete response was achieved again after 28.8 Gy whole brain and 24 Gy whole spine irradiation.
  • Histological examination revealed immature teratoma.
  • Enlargement of the recurrent mass at the trigone of the left lateral ventricle was found in spite of additional chemotherapy.
  • The patient died of tumour progression 34 months after the initial treatment.
  • By a combination of chemotherapy regiments in use today, the initial radiation field to treat intracranial germinomas should not be confined to the tumour bed.
  • [MeSH-major] Brain Neoplasms / drug therapy. Brain Neoplasms / radiotherapy. Germinoma / drug therapy. Germinoma / radiotherapy. Neoplasm Recurrence, Local. Pineal Gland / pathology
  • [MeSH-minor] Adult. Antineoplastic Combined Chemotherapy Protocols / therapeutic use. Cell Transformation, Neoplastic. Combined Modality Therapy. Disease Progression. Humans. Magnetic Resonance Imaging. Male. Radiosurgery

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  • (PMID = 12111494.001).
  • [ISSN] 0001-6268
  • [Journal-full-title] Acta neurochirurgica
  • [ISO-abbreviation] Acta Neurochir (Wien)
  • [Language] eng
  • [Publication-type] Case Reports; Journal Article
  • [Publication-country] Austria
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25. Kyritsis AP: Management of primary intracranial germ cell tumors. J Neurooncol; 2010 Jan;96(2):143-9

  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • Primary intracranial germ cell tumors are rare and usually localized in the pineal and the suprasellar regions.
  • They are divided into the following histologic types: germinoma, teratoma (mature, immature, malignant), choriocarcinoma, embryonal carcinoma, endodermal sinus tumor (yolk sac tumor), and mixed tumors.
  • Localized germinomas are treated with radiation therapy and exhibit a relatively good prognosis.
  • Chemotherapy is reserved for disseminated germinomas.
  • The rest of germ cell tumors are managed with various combinations of surgery, chemotherapy, and radiotherapy depending on the tumor type.
  • If the tumors secrete beta-human chorionic gonadotrophin (hCG) or alpha-fetoprotein (FP), these tumor markers can be used to accurately monitor response to treatment.
  • [MeSH-major] Neoplasms, Germ Cell and Embryonal / classification. Neoplasms, Germ Cell and Embryonal / therapy. Pinealoma / therapy
  • [MeSH-minor] Carcinoma, Embryonal / therapy. Germinoma / therapy. Humans. Magnetic Resonance Imaging / methods. Nerve Tissue Proteins / metabolism. Teratoma / therapy

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  • (PMID = 19588227.001).
  • [ISSN] 1573-7373
  • [Journal-full-title] Journal of neuro-oncology
  • [ISO-abbreviation] J. Neurooncol.
  • [Language] eng
  • [Publication-type] Journal Article; Review
  • [Publication-country] United States
  • [Chemical-registry-number] 0 / Nerve Tissue Proteins
  • [Number-of-references] 42
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26. Halperin EC: Neonatal neoplasms. Int J Radiat Oncol Biol Phys; 2000 Apr 1;47(1):171-8
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • PURPOSE: To describe neoplasms diagnosed in children </= 28 days of age along with their treatment, associated congenital anomalies, and the long-term consequences of the diagnoses and treatments.
  • The 20 patients identified via the computerized registry system for 1980-1998 constitute 2% (20/925) of all neoplasms seen in patients </= 16 years of age over this same time period at DUMC.
  • The histologic diagnoses were teratoma/germ cell tumor (n = 8, 35%), neuroblastoma (n = 5, 22%), retinoblastoma (n = 4, 17%), primary central nervous system (CNS) tumor (n = 3, 13%), and one case each of rhabdomyosarcoma, glossal glial choristoma, and hemangioma in the setting of Kasabach-Merritt Syndrome.
  • Of the eight teratoma/germ cell tumor patients, 6 were female (75%) and 2 male (25%).
  • Two of the seven patients with immature teratomas or teratoma were long-term survivors following surgery.
  • The one patient with malignant germ cell tumor, treated with surgery and chemotherapy, died.
  • Two were treated with surgery + chemotherapy + radiotherapy; two with surgery + chemotherapy; and one with surgery alone.
  • A child with a dumbbell neuroblastoma, treated with surgery and chemotherapy, is paraplegic.
  • The two children with trilateral retinoblastoma died after therapy with surgery, craniospinal and orbital irradiation, and chemotherapy.
  • Two children with bilateral disease are long-term survivors: one treated with radiotherapy + chemotherapy and one with radiotherapy alone.
  • Two of the patients are long-term survivors after surgery + chemotherapy.
  • Six children received eight courses of radiation therapy: 2 for Stage 4S neuroblastoma with respiratory compromise from an enlarging liver and 4 for retinoblastoma.
  • The two infants with trilateral retinoblastoma received two courses of irradiation each: one of the treatment of intraocular tumor and a second, at an older age, for the pineal tumor.
  • CONCLUSION: The most common neonatal neoplasm histologic diagnoses are teratoma/germ cell tumor, neuroblastoma, and retinoblastoma.
  • Radiation therapy is administered infrequently in a population highly susceptible to late ill effects.
  • When radiotherapy is required, anesthesia may be repetitively administered to aid in reproducible treatment.
  • [MeSH-minor] Anesthesia. Brain Neoplasms / epidemiology. Brain Neoplasms / pathology. Brain Neoplasms / therapy. Female. Follow-Up Studies. Hemangioma / epidemiology. Hemangioma / pathology. Hemangioma / therapy. Humans. Infant, Newborn. Male. Neuroblastoma / epidemiology. Neuroblastoma / pathology. Neuroblastoma / therapy. Registries. Retinoblastoma / epidemiology. Retinoblastoma / pathology. Retinoblastoma / therapy. Survivors. Teratoma / epidemiology. Teratoma / pathology. Teratoma / therapy

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  • (PMID = 10758320.001).
  • [ISSN] 0360-3016
  • [Journal-full-title] International journal of radiation oncology, biology, physics
  • [ISO-abbreviation] Int. J. Radiat. Oncol. Biol. Phys.
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] UNITED STATES
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27. Sawamura Y: Strategy of combined treatment of germ cell tumors. Prog Neurol Surg; 2009;23:86-95
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] Strategy of combined treatment of germ cell tumors.
  • Pineal GCTs can be grossly divided into three categories: those with a good, intermediate, and poor prognostic.
  • Germinoma and mature teratoma are curable and classified into the good prognostic group, whereas embryonal carcinoma, yolk sac tumor, and other highly malignant neoplasms leave patients with a dismal prognosis.
  • There are other types of GCT that have an intermediate prognosis, such as immature teratoma.
  • Only mature teratomas are curable by surgical resection alone; the other types require adjuvant therapy.
  • To plan a surgical strategy, then eurosurgeon has to acquire enough knowledge of the effect of adjuvant therapies and biological behavior of the GCTs.
  • Germinoma can be cured by low-dose radiotherapy in combination with chemotherapy, and nowadays needs only to be biopsied.
  • Other tumors, such as highly malignant tumors need a sophisticated combination therapy that includes surgery, craniospinal radiation therapy, and intensive chemotherapy.
  • An appropriate neoadjuvant therapy prior toradical surgical removal will remarkably reduce the surgical risk.
  • The goal of treatment should be tightly focused on the reduction of posttreatment sequelae, including surgical morbidity, and not on a complete microsurgical resection.
  • [MeSH-major] Brain Neoplasms. Neoplasms, Germ Cell and Embryonal. Pineal Gland. Pinealoma
  • [MeSH-minor] Combined Modality Therapy. Humans

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  • [Copyright] Copyright (c) 2009 S. Karger AG, Basel.
  • (PMID = 19329863.001).
  • [ISSN] 0079-6492
  • [Journal-full-title] Progress in neurological surgery
  • [ISO-abbreviation] Prog Neurol Surg
  • [Language] eng
  • [Publication-type] Journal Article; Review
  • [Publication-country] Switzerland
  • [Number-of-references] 19
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28. Brandes AA, Pasetto LM, Monfardini S: The treatment of cranial germ cell tumours. Cancer Treat Rev; 2000 Aug;26(4):233-42
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] The treatment of cranial germ cell tumours.
  • Germ cell tumours of the central nervous system (CNS) include many subtypes whose response to treatment varies, even though the symptoms and radiological appearances are similar.
  • Patients with choriocarcinoma, embryonal carcinoma, or yolk sac tumour have the lowest survival rates; patients with germinoma or mature teratoma have longer survival rates.
  • Although a wider resection is associated with a higher rate of survival for patients with non-germinomatous germ cell (NGGC) tumours, to date an aggressive surgical approach has been advocated only for pineal region tumours, but not for hypothalamic/neurohypophyseal tumours.
  • Beside the delayed injury induced by radiotherapy, the late injury induced by chemotherapy is becoming increasingly evident.
  • Cisplatin is considered an indispensable drug, but it may cause renal damage, ototoxicity, peripheral neuropathy and sterility, while etoposide is associated with an excess frequency of second neoplasms.
  • Taking into account all of the published literature, the following therapeutic options are suggested: in pure germinoma tumours (GT) radiotherapy alone will usually ensure adequate control of the disease, and the long-term sequelae may be limited by reducing the dose delivered, as was proposed for germ cell testicular tumours, to 30 Gy to limited fields plus 25-30 Gy to the spinal axis if there is disseminated disease.
  • In cases of recurrence, which should be uncommon, patients may be rescued with both radiotherapy and chemotherapy.
  • In NGGC tumours, the prognosis is more unfavourable and there is often dissemination to the spine at diagnosis; however, the tumour's high chemosensitivity suggests neoadjuvant treatment chemotherapy with cisplatin and etoposide for three cycles followed by consolidation radiotherapy with 40 Gy to the limited fields plus 30 Gy to the spinal axis if disseminated.
  • In our opinion, a higher dose of radiotherapy in cases in which chemotherapy does not achieve a radiological complete remission is not advisable, because very often the residual radiological abnormality does not represent biologically active tumour but differentiated forms such as mature teratoma.
  • The challenge for 2000 is to both cure these patients, and avoid the late and permanent sequelae of radiation and/or chemotherapy that may subsequently impair quality of life.
  • [MeSH-major] Brain Neoplasms / therapy. Neoplasms, Germ Cell and Embryonal / therapy
  • [MeSH-minor] Combined Modality Therapy. Cranial Irradiation. Drug Therapy. Humans. Neurosurgical Procedures. Prognosis. Radiotherapy Dosage. Survival Rate

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  • [Copyright] Copyright 2000 Harcourt Publishers Ltd.
  • (PMID = 10913379.001).
  • [ISSN] 0305-7372
  • [Journal-full-title] Cancer treatment reviews
  • [ISO-abbreviation] Cancer Treat. Rev.
  • [Language] eng
  • [Publication-type] Journal Article; Research Support, Non-U.S. Gov't; Review
  • [Publication-country] ENGLAND
  • [Number-of-references] 59
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29. Chen ML, McComb JG, Krieger MD: Atypical teratoid/rhabdoid tumors of the central nervous system: management and outcomes. Neurosurg Focus; 2005 Jun 15;18(6A):E8

  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • They commonly present in childhood, and have a rapidly progressive clinical course with a survival time of less than 1 year.
  • Treatment regimens have been nonuniform.
  • In this retrospective review of patients with ATRTs who were treated at the authors' institution according to a uniform protocol, the goal was to assess the efficacy of the treatment and its outcome.
  • Tumor location was cortical in four patients, in the pineal region in four, in the posterior fossa in two, and spinal in one.
  • Treatment consisted of chemotherapy in 11 patients, chemotherapy and local radiation in five, and chemotherapy and craniospinal radiation in three.
  • The mean time to death was 24 months, and ranged from 2 to 67 months.
  • The median time to progression was 3.5 months.
  • Further study is necessary to determine the efficacy of therapy.
  • [MeSH-major] Central Nervous System Neoplasms / therapy. Rhabdoid Tumor / therapy. Teratoma / therapy
  • [MeSH-minor] Adolescent. Child. Child, Preschool. Female. Follow-Up Studies. Humans. Infant. Magnetic Resonance Imaging / methods. Male. Retrospective Studies. Treatment Outcome

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  • (PMID = 16048294.001).
  • [ISSN] 1092-0684
  • [Journal-full-title] Neurosurgical focus
  • [ISO-abbreviation] Neurosurg Focus
  • [Language] eng
  • [Publication-type] Comparative Study; Journal Article
  • [Publication-country] United States
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30. Koh EJ, Phi JH, Park SH, Kim IO, Cheon JE, Wang KC, Cho BK, Kim SK: Mixed germ cell tumor of the midbrain. Case Report. J Neurosurg Pediatr; 2009 Aug;4(2):137-42

  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • The histopathological diagnosis was of a mixed germ cell tumor (GCT) comprising mature teratoma and germinoma cells with syncytiotrophoblastic giant cells.
  • The patient underwent postoperative chemotherapy and radiotherapy, and no tumor progression was found during 1 year of follow-up.
  • Intracranial GCTs arise mainly in the pineal and the suprasellar area.
  • To the authors' knowledge, this is the first reported case of a mixed GCT in the midbrain combining mature teratoma and germinoma cells.
  • [MeSH-major] Brain Stem Neoplasms / diagnosis. Brain Stem Neoplasms / therapy. Neoplasms, Germ Cell and Embryonal / diagnosis. Neoplasms, Germ Cell and Embryonal / therapy

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  • (PMID = 19645547.001).
  • [ISSN] 1933-0707
  • [Journal-full-title] Journal of neurosurgery. Pediatrics
  • [ISO-abbreviation] J Neurosurg Pediatr
  • [Language] eng
  • [Publication-type] Case Reports; Journal Article; Research Support, Non-U.S. Gov't
  • [Publication-country] United States
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