Extraneural recurrence of an intracranial nongerminomatous germ cell tumor to cervical lymph nodes in a pediatric patient: Case report.
germ cell tumor
high-dose chemotherapy
salvage therapy
Journal
Cancer reports (Hoboken, N.J.)
ISSN: 2573-8348
Titre abrégé: Cancer Rep (Hoboken)
Pays: United States
ID NLM: 101747728
Informations de publication
Date de publication:
08 2022
08 2022
Historique:
revised:
10
09
2021
received:
09
03
2021
accepted:
25
10
2021
pubmed:
20
11
2021
medline:
9
8
2022
entrez:
19
11
2021
Statut:
ppublish
Résumé
Intracranial germ cell tumors (GCTs) comprise 3%-5% of pediatric primary central nervous system (CNS) tumors in Western countries. Though they are related in embryonic origin to gonadal GCTs, which are considered highly treatable with cisplatin-based chemotherapy regimens, intracranial GCTs vary in malignant potential and sensitivity to radiation and chemotherapy, generally carrying a worse prognosis. Metastases of intracranial GCTs outside of the CNS are rare, indicate a poor prognosis, and their salvage treatment is not well established. A 15-year-old boy presented with bifocal (suprasellar and pineal) intracranial nongerminomatous germ cell tumors of mixed origin. The tumors were treated to full response with a multimodal approach of neoadjuvant chemotherapy, surgical resection, and adjuvant craniospinal proton radiation. Nine months following treatment completion, the patient presented with an enlarged cervical lymph node determined on excisional biopsy to be a recurrence of pure germinoma from the primary tumors. Salvage treatment involved high-dose chemotherapy and autologous stem cell transplantation; however, the patient denied further treatment prior to planned focal radiotherapy. Thirty months post-treatment, the patient is well with no evidence of recurrence. This case demonstrated the successful salvage treatment of an extraneural recurrence of an intracranial GCT using surgical resection and a high-dose chemotherapy and autologous stem-cell transplantation regimen, highlighting the unique factors which led to the selection of this regimen.
Sections du résumé
BACKGROUND
Intracranial germ cell tumors (GCTs) comprise 3%-5% of pediatric primary central nervous system (CNS) tumors in Western countries. Though they are related in embryonic origin to gonadal GCTs, which are considered highly treatable with cisplatin-based chemotherapy regimens, intracranial GCTs vary in malignant potential and sensitivity to radiation and chemotherapy, generally carrying a worse prognosis. Metastases of intracranial GCTs outside of the CNS are rare, indicate a poor prognosis, and their salvage treatment is not well established.
CASE
A 15-year-old boy presented with bifocal (suprasellar and pineal) intracranial nongerminomatous germ cell tumors of mixed origin. The tumors were treated to full response with a multimodal approach of neoadjuvant chemotherapy, surgical resection, and adjuvant craniospinal proton radiation. Nine months following treatment completion, the patient presented with an enlarged cervical lymph node determined on excisional biopsy to be a recurrence of pure germinoma from the primary tumors. Salvage treatment involved high-dose chemotherapy and autologous stem cell transplantation; however, the patient denied further treatment prior to planned focal radiotherapy. Thirty months post-treatment, the patient is well with no evidence of recurrence.
CONCLUSION
This case demonstrated the successful salvage treatment of an extraneural recurrence of an intracranial GCT using surgical resection and a high-dose chemotherapy and autologous stem-cell transplantation regimen, highlighting the unique factors which led to the selection of this regimen.
Identifiants
pubmed: 34796700
doi: 10.1002/cnr2.1586
pmc: PMC9351648
doi:
Types de publication
Case Reports
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
e1586Informations de copyright
© 2021 The Authors. Cancer Reports published by Wiley Periodicals LLC.
Références
Nat Neurosci. 2018 Oct;21(10):1380-1391
pubmed: 30224810
Neuro Oncol. 2013 Jun;15(6):788-96
pubmed: 23460321
Br J Neurosurg. 2011 Dec;25(6):747-9
pubmed: 21501064
Int J Radiat Oncol Biol Phys. 2012 Nov 1;84(3):625-31
pubmed: 22420971
Int J Radiat Oncol Biol Phys. 1989 Jun;16(6):1405-9
pubmed: 2542195
Acta Neuropathol. 2007 Aug;114(2):97-109
pubmed: 17618441
J Clin Oncol. 2015 Aug 1;33(22):2464-71
pubmed: 26101244
Neuro Oncol. 2017 Nov 29;19(12):1661-1672
pubmed: 29048505
J Neurosurg. 1973 Feb;38(2):226-31
pubmed: 4540397
Urol Oncol. 2015 Aug;33(8):355-62
pubmed: 25837842
Ann Oncol. 2008 Mar;19(3):448-53
pubmed: 18006893
Neoplasma. 1962;9:585-92
pubmed: 13991553
Pediatr Neurosurg. 2013;49(3):155-8
pubmed: 24751890
J Neurosurg. 1980 Oct;53(4):562-5
pubmed: 7420182
Neurol India. 2007 Apr-Jun;55(2):151-3
pubmed: 17558121
Clin Neuropathol. 1988 May-Jun;7(3):131-3
pubmed: 3203482
Cancer. 1984 Feb 15;53(4):974-81
pubmed: 6692295
Zhonghua Yi Xue Za Zhi (Taipei). 1992 May;49(5):354-64
pubmed: 1320996
Brain Tumor Pathol. 2012 Oct;29(4):245-50
pubmed: 22286191
J Clin Oncol. 2017 Apr 1;35(10):1096-1102
pubmed: 27870561
Oncologist. 2008 Jun;13(6):690-9
pubmed: 18586924
J Pediatr Hematol Oncol. 2012 Jan;34(1):e12-6
pubmed: 22215101
Radiat Oncol. 2014 Jun 06;9:130
pubmed: 24906388
Oncol Res Treat. 2018;41(6):365-369
pubmed: 29843143
J Oncol Pract. 2016 May;12(5):437-43
pubmed: 27170693
Cancer Rep (Hoboken). 2022 Aug;5(8):e1586
pubmed: 34796700
Zentralbl Neurochir. 1957;17(3):129-40
pubmed: 13497167
Int J Radiat Oncol Biol Phys. 1998 Aug 1;42(1):143-6
pubmed: 9747831
Pediatr Neonatol. 2015 Oct;56(5):301-6
pubmed: 25769700
Radiat Oncol. 2012 Jun 26;7:104
pubmed: 22734595
Lancet Oncol. 2015 Sep;16(9):e470-e477
pubmed: 26370356