[Germ-cell tumors of the brain--their course and management]

Germ-cell tumors (GCT) of the CNS constitute a small group with an incidence varying in the range 0.1 to 3.4 per cent of all primary brain neoplasms. In the WHO classification of brain tumors they are differentiated in a separate group, and further subdivided into: germinoma, teratoma (mature, immature, malignant), embryonal carcinoma, choriocarcinoma, endodermal sinus tumor and mixed germinal tumors. Of them germinoma is the most frequently encountered (41-65 per cent of all GCT), whereas the incidence rate of mixed GCT may reach 32 per cent Mainly median structures are being involved--III ventricle (pineal region and hypothalamo-hypophyseal structures), basal ganglia, with isolated cases being described in corpus callosum, cerebellum, medulla oblongata and spinal cord. Eleven patients with a total of 13 verified GCT are presented (in one instance germinomas involving the pineal body and suprasellar region are simultaneously established). The clinical course data, results of the diagnostic examinations done (CT, brain angiography, tumor markers), treatment carried out--surgical, radio- and chemotherapy, as well as the outcome of the long-term follow-up study of patients are analyzed. Three patients have mixed GCT. It is of interest to note a case where ten years after the removal of a benign teratoma in the pineal region, germinoma in the same location is diagnosed and removed.