Cytologic diagnosis of pineal germinoma in cerebrospinal fluid and sputum

The cytologic findings in an unusual case of primary germinoma of the pineal region which metastasized to the lungs are presented and compared with those in a case of typical testicular seminoma metastatic to the central nervous system (CNS). Tumor cells in Papanicolaou- or Wright's-stained cytocentrifuge preparations and Papanicolaou-stained sputum smears could all be readily compared to biopsies of the primary tumors. Large round nuclei with dispersed chromatin and multiple, prominent nucleoli were important identifying features. The cytoplasm was usually scanty and often vacuolated. Human chorionic gonadotropin (HCG) (8 ng/ml of the beta subunit) appeared in the cerebrospinal fluid (CSF) of the patient with pineal germinoma, indicating that trophoblasts were present in the tumor even though none were seen in the biopsy or cytologic preparations. CSF polyamine levels, a test with 81% sensitivity and 66% specificity for brain tumors, were normal in the same patient. A comparison of tumor cells from both cases illustrates the similarity of germinoma cells from pineal primary tumors and testicular tumors metastic to the CNS. Although the identification of malignant germ cells in body fluids remains a grave prognostic sign, treatment with vincristine, bleomycin and cis-platinum is now inducing progressively longer remissions. Cytology should play an increasingly greater role in monitoring disease activity in patients receiving long-term treatment for malignant germ cell tumors in all locations.