The Southern Medical Journal (SMJ) is the official, peer-reviewed journal of the Southern Medical Association. It has a multidisciplinary and inter-professional focus that covers a broad range of topics relevant to physicians and other healthcare specialists.

SMJ // Article

Review Article

Pineal Germinoma

Authors: Nandakumar Srinivasan, MD, Aneesh Pakala, MD, Chandana Mukkamalla, MD, Alok Oswal, MD

Abstract

Germinomas are gonadal neoplasms that rarely occur extragonadally in the midline structures of the human body. Newly diagnosed adult cases of pineal gland germinomas are very rare since most of the cases are diagnosed in the mid teens. The estimated incidence of this tumor in western countries is between 0.4–3.4%. Typically, this tumor is diagnosed by its characteristic radiological appearance alone, supported by tumor marker(s) or by stereotactic biopsy of the tumor. We are reporting a very unique case of pineal germinoma diagnosed in an adult at our institute by cerebrospinal fluid cytology with literature review. We analyzed case reports, literature reviews, and therapy and diagnostic articles about pineal germinoma in the English literature from 1983 to 2009 through the national library of medicine, Pubmed, and OVID search engines. We used key words “pineal germinoma,” “pineal gland tumor,” “CNS germinoma,” and “extragonodal germinomas” to search for our articles.

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References

1. Shim KW, Kim DS, Choi JU. Mixed or metachronous germ-cell tumor? Childs Nerv Syst 2007;23:713–718.
 
2. Aker FV, Berkman ZM, Aydingöz I, et al. Pineal germinoma associated with multiple congenital melanocytic nevi: a unique presentation. Neuropathology 2005;25:336–340.
 
3. Cuccia V, Galarza M. Pure pineal germinomas: analysis of gender incidence. Acta Neurochir (Wien) 2006;148:865–871; discussion 871.
 
4. Reisch N, Kühne-Eversmann L, Franke D, et al. Intracranial germinoma as a very rare cause of panhypopituitarism in a 23-year old man. Exp Clin Endocrinol Diabetes 2009;117:320–323.
 
5. Lafay-Cousin L, Millar BA, Mabbott D, et al. Limited-field radiation for bifocal germinoma. Int J Radiat Oncol Biol Phys 2006;65:486–492.
 
6. Reddy AT, Wellons JC III, Allen JC, et al. Refining the staging evaluation of pineal region germinoma using neuroendoscopy and the presence of preoperative diabetes insipidus. Neuro Oncol 2004;6:127–133.
 
7. Packer RJ, Cohen BH, Cooney K. Intracranial germ cell tumors. Oncologist 2000;5:312–320.
 
8. Lee L, Saran F, Hargrave D, et al. Germinoma with synchronous lesions in the pineal and suprasellar regions. Childs Nerv Syst 2006;22:1513–1518.
 
9. Jennings MT, Gelman R, Hochberg F. Intracranial germ-cell tumors: natural history and pathogenesis. J Neurosurg 1985;63:155–167.
 
10. Chang T, Teng MM, Guo WY, et al. CT of pineal tumors and intracranial germ-cell tumors. AJR Am J Roentgenol 1989;153:1269–1274.
 
11. Sano K. So-called intracranial germ cell tumours: are they really of germ cell origin? Br J Neurosurg 1995;9:391–401.
 
12. Chao CK, Lee ST, Lin FJ, et al. A multivariate analysis of prognostic factors in management of pineal tumor. Int J Radiat Oncol Biol Phys 1993;27:1185–1191.
 
13. Wong TT, Yen SH, Ho DM, et al. Pineal germinoma with intratumoral hemorrhage after neuroendoscopic tumor biopsy. Childs Nerv Syst 2003;19:769–772.
 
14. Hasle H, Mellemgaard A, Nielsen J, et al. Cancer incidence in men with Klinefelter syndrome. Br J Cancer 1995;71:416–420.
 
15. De Vile CJ, Sufraz R, Lask BD, et al. Occult intracranial tumours masquerading as early onset anorexia nervosa. BMJ 1995;311:1359–1360.
 
16. Winston AP, Barnard D, D'Souza G, et al. Pineal germinoma presenting as anorexia nervosa: case report and review of the literature. Int J Eat Disord 2006;39:606–608.
 
17. Ahmed SR, Shalet SM, Price DA, et al. Human chorionic gonadotrophin secreting pineal germinoma and precocious puberty. Arch Dis Child 1983;58:743–745.
 
18. Laidler P, Pounder DJ. Pineal germinoma with syncytiotrophoblastic giant cells: a case with panhypopituitarism and isosexual pseudopuberty. Hum Pathol 1984;15:285–287.
 
19. Chang CW, Hay D, Chang TS, et al. Retinal periphlebitis in a patient with pineal germinoma. Arch Ophthalmol 1999;117:1434–1436.
 
20. Wenger M, Lövblad KO, Markwalder R, et al. Late recurrence of pineal germinoma. Surg Neurol 2002;57:34–39; discussion 39–40.
 
21. Nishibayashi H, Uematsu Y, Terada T, et al. Pineal Germinoma with granulomatous reaction: case report. Neurol Med Chir (Tokyo) 2005;45:415–417.
 
22. Liang L, Korogi Y, Sugahara T, et al. MRI of intracranial germ-cell tumours. Neuroradiology 2002;44:382–388.
 
23. Chandrasoma PT, Smith MM, Apuzzo ML. Stereotactic biopsy in the diagnosis of brain masses: comparison of results of biopsy and resected surgical specimen. Neurosurgery 1989;24:160–165.
 
24. Kraichoke S, Cosgrove M, Chandrasoma PT. Granulomatous inflammation in pineal germinoma. A cause of diagnostic failure at stereotaxic brain biopsy. Am J Surg Pathol 1988;12:655–660.
 
25. Grimoldi N, Tomei G, Stankov B, et al. Neuroendocrine, immunohistochemical, and ultrastructural study of pineal region tumors. J Pineal Res 1998;25:147–158.
 
26. Hirato J, Nakazato Y. Pathology of pineal region tumors. J Neurooncol 2001;54:239–249.
 
27. Ono N, Inoue HK, Naganuma H, et al. Diagnosis of germinal neoplasm in the thalamus and basal ganglia. Surg Neurol 1986;26:24–28.
 
28. Takeshima H, Kuratsu J. A review of soluble c-kit (s-kit) as a novel tumor marker and possible molecular target for the treatment of CNS germinoma. Surg Neurol 2003;60:321–324; discussion 324–325.
 
29. Buccoliero AM, Sardi I, Castiglione F, et al. Pineal germinoma morphological features in a liquid-based cerebrospinal fluid sample. Diagn Cytopathol 2008;36:645–646.
 
30. Tosaka M, Ogimi T, Itoh J, et al. Spinal epidural metastasis from pineal germinoma. Acta Neurochir (Wien) 2003;145:407–410; discussion 410.
 
31. Calaminus G, Bamberg M, Baranzelli MC, et al. Intracranial germ cell tumors: a comprehensive update of the European data. Neuropediatrics 1994;25:26–32.
 
32. Aydin F, Ghatak NR, Radie-Keane K, et al. The short-term effect of low-dose radiation on intracranial germinoma. A pathologic study. Cancer. 1992;69:2322–2326.
 
33. Dattoli MJ, Newall J. Radiation therapy for intracranial germinoma: the case for limited volume treatment. Int J Radiat Oncol Biol Phys 1990;19:429–433.
 
34. Endo H, Kumabe T, Jokura H, et al. Stereotactic radiosurgery followed by whole ventricular irradiation for primary intracranial germinoma of the pineal region. Minim Invasive Neurosurg 2005;48:186–190.
 
35. Itoyama Y, Kochi M, Yamashiro S, et al. Combination chemotherapy with cisplatin and etoposide for hematogenous spinal metastasis of intracranial germinoma—case report. Neurol Med Chir (Tokyo) 1993;33:28–31.
 
36. Hupperets PS, Defesche HF, de Bruijckere LM, et al. The role of chemotherapy in intracranial germinoma: a case report. Ann Oncol 1999;10:723–726.
 
37. Pinkerton CR, Broadbent V, Horwich A, et al. ‘JEB’—a carboplatin based regimen for malignant germ cell tumours in children. Br J Cancer 1990;62:257–262.
 
38. Passarin MG, Vattemi E, Musso AM, et al. Intracranial granulocytic sarcoma after chemotherapy for pineal germinoma and testicular cancer. J Clin Oncol 2008;26:4507–4509.
 
39. Devkota J, Brooks BS, el Gammal. Ventriculoperitoneal shunt metastasis of a pineal germinoma. Comput Radiol 1984;8:141–145.
 
40. Murai Y, Kobayashi S, Mizunari T, et al. Spontaneous regression of a germinoma in the pineal body after placement of a ventriculoperitoneal shunt. J Neurosurg 2000;93:884–886.
 
41. Shibamoto Y, Sasai K, Oya N, et al. Intracranial germinoma: radiation therapy with tumor volume-based dose selection. Radiology 2001;218:452–456.
 
42. Howman-Giles R, Besser M, Johnston IH, et al. Disseminated hematogenous metastases from a pineal germinoma in an infant. Case report. J Neurosurg 1984;60:835–837.
 
43. Galassi E, Tognetti F, Frank F, et al. Extraneural metastases from primary pineal tumors. Review of the literature. Surg Neurol 1984;21:497–504.
 
44.Tsunoda S, Sasaoka Y, Sakaki T, et al. Suprasellar embryonal carcinoma which developed ten years after local radiation therapy for pineal germinoma. Surg Neurol 1993;40:146–150.
 
45. Ono N, Isobe I, Uki J, et al. Recurrence of primary intracranial germinomas after complete response with radiotherapy: recurrence patterns and therapy. Neurosurgery 1994;35:615–620; discussion 620–621.