Clinico-biological behavior of germ-cell tumors

Fifty-five patients with intracranial germ-cell tumors were treated in Kobe University Hospital between 1972 and 1989. Thirty-four patients were male and 21 were female, and all patients were between 0 and 39 years of age. There was a peak incidence between 16 and 20 years in male patients and 11 and 15 years in female patients. The tumors occurred most frequently in the pineal region (25 cases), followed by the suprasellar (17), both pineal and suprasellar (6), basal ganglia (5), and frontal and temporal lobe (2) regions. There was a male predominance in the incidence of germ-cell tumors except for the patients with suprasellar tumors. Initial symptoms and neurological signs differed according to the location of the tumor. The symptoms of increased intracranial pressure and Parinaud's sign were most frequently seen in patients with a pineal tumor, while diabetes insipidus and visual disturbance were most common in patients with suprasellar tumors. Human chorionic gonadotropin were positive in the serum, cerebrospinal fluid and/or tumor cyst in 14/26 patients, and alpha-fetoprotein in 6/22 patients examined. There were 45 patients with pure germinoma both histologically verified and clinically diagnosed. The 5-year survival rate of the patients with germinoma was 69% in cases in which tumor marker was negative and unknown cases, and 86% in cases where the tumor marker was positive. The authors discuss management of the patients with intracranial germ-cell tumors.