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Spinal intradural primary germ cell tumour--review of literature and case report.
Acta Neurochir (Wien). 2009 Mar; 151(3):277-84.AN

Abstract

BACKGROUND

Primary spinal cord germ cell tumour is a rare tumour. We herein review the tumour characteristics, associated risk factors, treatment policy, and patterns of failure of primary intradural germ cell tumour.

METHOD

We conducted a PUBMED search using a combination of keywords such as "spinal germ cell tumor," "germinoma," "extradural," "intradural," "intramedullary," "extramedullary," and identified 19 cases of primary spinal germ cell tumour. Clinical features, pathologic characteristics, and treatment details of these patients including status at follow-up were noted from respective case reports. We also describe a case of a young Indian patient of intradural extramedullary germ cell tumour treated with a combination of surgery, chemotherapy, and radiotherapy.

FINDINGS

The median age at presentation was 24 years. The most common location of the tumour was thoracic (40%). Beta-HCG overproduction was noted in 40% of the patients. Most patients were treated with a combination of surgery, radiation therapy, and systemic chemotherapy. Median follow-up was 16.5 months. Recurrence was observed in 10% of the patients, all in beta-HCG over-producing tumours. The illustrative case was a 28-year male, presenting with pain in lower back and both lower limbs for 2 months. Magnetic resonance imaging spine showed an inhomogeneous hyperintense soft tissue mass at L(2)-L(4) spinal level. He was treated with complete surgical excision and four cycles of chemotherapy with BEP regimen following a histological diagnosis of non-seminomatous germ cell tumour. Palliative irradiation to the lumbar spine was given on progression at 3 months. The patient eventually succumbed to his condition, due to compressive transverse myelitis possibly due to cervical cord metastasis.

CONCLUSION

Limited surgery followed by upfront radiation therapy and adjuvant chemotherapy is the optimal management of this rare group of tumour. Omission of radiation therapy from the treatment armamentarium might engender local recurrence and spinal dissemination at first failure.

Authors+Show Affiliations

Department of Radiotherapy, All India Institute of Medical Sciences, New Delhi, India. dr_ahitagni@yahoo.co.inNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Case Reports
Journal Article
Review

Language

eng

PubMed ID

19240975

Citation

Biswas, Ahitagni, et al. "Spinal Intradural Primary Germ Cell Tumour--review of Literature and Case Report." Acta Neurochirurgica, vol. 151, no. 3, 2009, pp. 277-84.
Biswas A, Puri T, Goyal S, et al. Spinal intradural primary germ cell tumour--review of literature and case report. Acta Neurochir (Wien). 2009;151(3):277-84.
Biswas, A., Puri, T., Goyal, S., Gupta, R., Eesa, M., Julka, P. K., & Rath, G. K. (2009). Spinal intradural primary germ cell tumour--review of literature and case report. Acta Neurochirurgica, 151(3), 277-84. https://doi.org/10.1007/s00701-009-0200-1
Biswas A, et al. Spinal Intradural Primary Germ Cell Tumour--review of Literature and Case Report. Acta Neurochir (Wien). 2009;151(3):277-84. PubMed PMID: 19240975.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Spinal intradural primary germ cell tumour--review of literature and case report. AU - Biswas,Ahitagni, AU - Puri,Tarun, AU - Goyal,Shikha, AU - Gupta,Ruchika, AU - Eesa,Muneer, AU - Julka,Pramod Kumar, AU - Rath,Goura Kishor, Y1 - 2009/02/25/ PY - 2007/10/11/received PY - 2008/10/27/accepted PY - 2009/2/26/entrez PY - 2009/2/26/pubmed PY - 2009/6/24/medline SP - 277 EP - 84 JF - Acta neurochirurgica JO - Acta Neurochir (Wien) VL - 151 IS - 3 N2 - BACKGROUND: Primary spinal cord germ cell tumour is a rare tumour. We herein review the tumour characteristics, associated risk factors, treatment policy, and patterns of failure of primary intradural germ cell tumour. METHOD: We conducted a PUBMED search using a combination of keywords such as "spinal germ cell tumor," "germinoma," "extradural," "intradural," "intramedullary," "extramedullary," and identified 19 cases of primary spinal germ cell tumour. Clinical features, pathologic characteristics, and treatment details of these patients including status at follow-up were noted from respective case reports. We also describe a case of a young Indian patient of intradural extramedullary germ cell tumour treated with a combination of surgery, chemotherapy, and radiotherapy. FINDINGS: The median age at presentation was 24 years. The most common location of the tumour was thoracic (40%). Beta-HCG overproduction was noted in 40% of the patients. Most patients were treated with a combination of surgery, radiation therapy, and systemic chemotherapy. Median follow-up was 16.5 months. Recurrence was observed in 10% of the patients, all in beta-HCG over-producing tumours. The illustrative case was a 28-year male, presenting with pain in lower back and both lower limbs for 2 months. Magnetic resonance imaging spine showed an inhomogeneous hyperintense soft tissue mass at L(2)-L(4) spinal level. He was treated with complete surgical excision and four cycles of chemotherapy with BEP regimen following a histological diagnosis of non-seminomatous germ cell tumour. Palliative irradiation to the lumbar spine was given on progression at 3 months. The patient eventually succumbed to his condition, due to compressive transverse myelitis possibly due to cervical cord metastasis. CONCLUSION: Limited surgery followed by upfront radiation therapy and adjuvant chemotherapy is the optimal management of this rare group of tumour. Omission of radiation therapy from the treatment armamentarium might engender local recurrence and spinal dissemination at first failure. SN - 0942-0940 UR - https://www.unboundmedicine.com/medline/citation/19240975/Spinal_intradural_primary_germ_cell_tumour__review_of_literature_and_case_report_ L2 - https://dx.doi.org/10.1007/s00701-009-0200-1 DB - PRIME DP - Unbound Medicine ER -