Germinatívne nádory pineálnej oblasti: prehľad

English version

Autoři: V. Miskovska ¹; V. Usakova ²; B. Vertakova-Krakovska ²; B. Mrinakova ²; V. Lehotská ³; M. Chorvath ⁴; B. Rychlý ⁵; J. Steno ⁶; D. Ondrus ¹
Působiště autorů: 1st Department of Oncology, Comenius University, Faculty of Medicine, St. Elisabeth Cancer Institute, Bratislava, Slovak Republic ¹; Department of Medical Oncology, St. Elisabeth Cancer Institute, Bratislava, Slovak Republic ²; 2nd Department of Radiodiagnostics, Comenius University, Faculty of Medicine, St. Elisabeth Cancer Institute, Bratislava, Slovak Republic ³; Department of Radiation Oncology, Slovak Medical University, St. Elisabeth Cancer Institute, Bratislava, Slovak Republic ⁴; Cytopathos, Bratislava, Slovak Republic ⁵; Department of Neurosurgery, Comenius University, Faculty of Medicine, University Hospital, Bratislava, Slovak Republic ⁶
Vyšlo v časopise: Klin Onkol 2013; 26(1): 19-24
Kategorie: Přehledy

Autoři deklarují, že v souvislosti s předmětem studie nemají žádné komerční zájmy.

Redakční rada potvrzuje, že rukopis práce splnil ICMJE kritéria pro publikace zasílané do bi omedicínských časopisů.

Obdrženo: 25. 11. 2012

Přijato: 2. 12. 2012

Souhrn

Úvod:
Primárne intrakraniálne germinatívne tumory predstavujú zriedkavú skupinu nádorov, ktoré sa vyskytujú v detstve a u mladých dospelých. WHO klasifikácia delí intrakraniálne tumory na germinómy a negerminómy. Najčastejšia lokalita týchto nádorov je pineálna a supraselárna oblasť. Klinické príznaky a symptómy závisia od lokalizácie tumoru, najčastejšie sú to príznaky v dôsledku zvýšeného intrakraniálnho tlaku, Parinaudov syndróm, bitemporálna hemianopsia, príznaky z endokrinného deficitu. Zobrazovacím vyšetrením voľby pri diagnostike intrakraniálnych germinatívnych tumorov je MRI vyšetrenie mozgu s použitím kontrastnej látky gadolinium. Zobrazovacie vyšetrenia však neposkytnú dostatočnú informáciu o type nádoru, k tomu je potrebná bioptizácia. Výnimkou sú prípady s charakteristicky zvýšenými hladinami nádorových markerov (AFP a β-hCG) stanovenými v sére a cerebrospinálnom moku.

Klinický prípad:
U 26-ročného pacienta so zhoršeným zrakom s poruchou zaostriť a svetloplachosťou, výraznou únavou a ospalosťou, nevoľnosťou, občasným zvracaním, s intermitentnými bolesťami hlavy a klinicky prítomným Parinaudovým syndróm sa zistil germinatívny nádor pineálnej oblasti. Zrealizované MR vyšetrenie mozgu ukázalo tumoróznu expanziu v pineálnej oblasti a v pravej časti mezencefala. Bola vykonaná radikálna exstirpácia tumoru v pineálnej oblasti. Pri kontrolnom MR vyšetrení mozgu sa zistila recidíva ochorenia. Pacient absolvoval kraniospinálne ožiarenie s následnou pooperačnou chemoterapiou (schéma cisplatina a etoposid), celkovo tri cykly. V súčasnej dobe je pacient 30 mesiacov po ukončení úspešnej onkologickej liečby v klinickej remisii ochorenia.

Záver:
Liečba a prognóza tohto nádorového ochorenia je rozdielna v jednotlivých skupinách. Germinómy majú lepšie prežívanie než negerminómy. 5-ročné prežívanie germinómov po aplikácii samotnej rádioterapie bolo > 90 %. Pridanie chemoterapie viedlo k zníženiu dávky a zmenšeniu ožarovanej oblasti, s dosiahnutím menších nežiadúcich účinkov a bez zníženia kurability. Negerminómy sú menej rádiosenzitívne než germinómy, ale použitím adjuvantnej chemoterapie sa dosiahlo zlepšenie prežívania. Naďalej však menežment týchto nádorov ostáva kontroverzný.

Kľúčové slová:
pinealóm – germinóm – mozgové nádory – diagnóza – liečba

Zdroje

1. Felix I, Becker LE. Intracranial germ cell tumors in children: an immunohistochemical and electron microscopic study. Pediatr Neurosurg 1990; 16(3): 156–162.

2. Baucher L, Rigau V, Mathieu-Daude H et al. Clinical epidemiology for childhood primary central nervous system tumors. J Neurooncol 2009; 92(1): 87–98.

3. CBTRUS, Central Brain Tumor Registry of the United States (2009) Statistical Report 2004–2005. Available at http://www.cbtrus.org.

4. Mori K, Kurisaka M. Brain tumors in childhood: statistical analysis of cases from the Brain Tumor Registry of Japan. Child´s Nerv Syst 1986; 5(2): 233–237.

5. Cho KT, Wang KC, Kim SK et al. Pediatric brain tumors: statistics of SNUH, Korea (1959–2000). Childs Nerv Syst 2002; 18(1–2): 30–37.

6. Wong TT, Ho DM, Chang KP et al. Primary pediatric brain tumors: statistics of Taipei VGH, Taiwan (1975–2004). Cancer 2005; 104(10): 2156–2167.

7. Bentley AJ, Parkinson MC, Harding BN et al. A comparative morphological and immunohistochemical study of testicular seminomas and intracranial germinomas. Histopathology 1990; 17(5): 443–449.

8. Beeley JM, Daly JJ, Timperley WR et al. Ectopic pinealoma: an unusual clinical presentation and histochemical comparison with a seminoma of the testis. J Neurol Neurosurg Psychiatry 1973; 36(5): 864–873.

9. Louis DN, Ohgaki H, Wiestler OD et al. The 2007 WHO Classification of Tumours of the Central Nervous System. Acta Neuropathol 2007; 114(2): 97–109.

10. Jennings MT, Gelman R, Hochberg F. Intracranial germ-cell tumors: Natural history and pathogenesis. J Neurosurg 1985; 63(2): 155–167.

11. Masao M. Pineal Germ Cell Tumors. In: Kobayashi T, Lunsford LD (eds). Pineal Region Tumors. Diagnosis and Treatment Options. Prog Neurol Surgery. Basel Karger 2009; 23: 76–85.

12. Vedrine L, Bauduceau O, Fayolle M et al. Combined chemotherapy and radiation therapy for intracranial germinomas. The Val-de-Grace hospital experience. Cancer Radiother 2005; 9(5): 335–340.

13. Lapras C, Mottolese C, Jouvet A. Pineal region tumors. In: Choux M, Di Rocco C, Hockley A, Walker M (eds). Pediatric neurosurgery. London: Churchill Livingstone 1999: 549–560.

14. Matsutani M, Sano K, Takakura K et al. Primary intracranial germ cell tumors: a clinical analysis of 153 histologically verified cases. J Neurosurg 1997; 86(3): 446–455.

15. Saeki N, Takami K, Murai H et al. Long-term outcome of endocrine function in patients with neurohypophyseal germinomas. Endocr J 2000; 47(1): 83–89.

16. Allen JC, Nisselbaum J, Epstein F et al. Alphafetoprotein and human chorionic gonadotropin determination in cerebrospinal fluid. An aid to the diagnosis and management of intracranial germ-cell tumors. J Neurosurg 1979; 51(3): 368–374.

17. Inamura T, Nishio S, Ikezaki K et al. Human chorionic gonadotropin in CSF, not serum, predict outcome in germinoma. J Neurol Neurosurg Psychiatry 1999; 66(5): 654–657.

18. Shinoda J, Ymada H, Sakai N et al. Placental alkaline phosphatase as a tumor marker for primary intracranial germinoma. J Neurosurg 1988; 68(5): 710–720.

19. Kretschmar CS. Germ cell tumors of the brain in children: a review of current literature and new advances in therapy. Cancer Invest 1997; 15(2): 187–198.

20. Tien RD, Barkovich AJ, Edwards MS. MR imaging of pineal tumors. AJR Am J Roentgenol 1990; 155(1): 143–151.

21. Fujimaki T, Matsutani M, Funada N et al. CT and MRI features of intracranial germ cell tumors. J Neurooncol 1994; 19(3): 217–226.

22. Smirniotopoulos JG, Rushing EJ, Mena H. Pineal region masses: differential diagnosis. Radiographics 1992; 12(3): 577–596.

23. Sifat H, Haddadi K, el Ghazi E et al. Central nervous system germinoma: retrospective study of six cases. Cancer Radiother 2002; 6(5): 273–277.

24. Gauvrit JY, Soto Ares G, Hamon-Kerautret M et al. Imagerie des tumeurs de la région pinéale. Feuillets de Radiologie 1997; 37(4): 287–299.

25. Ray P, Jallo GI, Kim RY et al. Endoscopic third ventriculostomy for tumor-related hydrocephalus in a pediatric population. Neurosurg Focus 2005; 19(6): E8.

26. Kang JK, Jeun SS, Hong YK et al. Experience with pineal region tumors. Childs Nerv Syst 1998; 14(1–2): 63–68.

27. Echevarría ME, Fangusaro J, Goldman S. Pediatric Central Nervous System Germ Cell Tumors: A Review. The Oncologist 2008; 13(6): 690–699.

28. Packer RJ, Cohen BH, Cooney K. Intracranial germ cell tumors. The Oncologist 2000; 5(4): 312–320.

29. Balmaceda C, Finlay J. Current advances in the diagnosis and management of intracranial germ cell tumors. Curr Neurol Neurosci Rep 2004; 4(3): 253–262.

30. Sawamura Y, de Tribolet N, Ishii N et al. Management of primary intracranial germinomas: Diagnostic surgery or radical resection? J Neurosurg 1997; 87(2): 262–266.

31. O‘Callaghan AM, Katapodis O, Ellison DW et al. The growing teratoma syndrome in a nongerminomatous germ cell tumor of the pineal gland: A case report and review. Cancer 1997; 80(5): 942–947.

32. Sutton LN, Radcliffe J, Goldwein JW et al. Quality of life of adult survivors of germinomas treated with craniospinal irradiation. Neurosurg 1999; 45(6): 1292–1297.

33. Spiegler BJ, Bouffet E, Greenberg ML et al. Change in neurocognitive functioning after treatment with cranial radiation in childhood. J Clin Oncol 2004; 22(4): 706–713.

34. Benesh M, Lackner H, Schagerl S et al. Tumor- and treatment-related side effects after multimodal therapy of childhood intracranial germ cell tumors. Acta Paediatr 2001; 90(3): 264–270.

35. Sawamura Y, Ikeda J, Shirato H et al. Germ cell tumours of the central nervous system: Treatment consideration based on 111 cases and their long-term clinical outcomes. Eur J Cancer 1998; 34(1): 104–110.

36. Shibamoto Y, Takahashi M, Abe M. Reduction of the radiation dose for intracranial germinoma: A prospective study. Br J Cancer 1994; 70(5): 984–989.

37. Rogers SJ, Mosleh–Shirazi MA, Saran FH. Radiotherapy of localised intracranial germinoma: Time to sever historical ties? Lancet Oncol 2005; 6(7): 509–519.

38. Fouladi M, Grant R, Baruchel S et al. Comparison of survival outcomes in patients with intracranial germinomas treated with radiation alone versus reduced-dose radiation and chemotherapy. Childs Nerv Syst 1998; 14(10): 596–601.

39. Sawamura Y, Shirato H, Ikeda J et al. Induction chemotherapy followed by reduced-volume radiation therapy for newly diagnosed central nervous system germinoma. J Neurosurg 1998; 88(1): 66–72.

40. Aoyama H, Shirato H, Ikeda J et al. Induction chemotherapy followed by low-dose involved-field radiotherapy for intracranial germ cell tumors. J Clin Oncol 2002; 20(2): 857–865.

41. Hoffman HJ, Otsubo H, Hendrick EB et al. Intracranial germ-cell tumors in children. J Neurosurg 1991; 74(4): 545–551.

42. Robertson PL, DaRosso RC, Allen JC. Improved prognosis of intracranial non-germinoma germ cell tumors with multimodality therapy. J Neurooncol 1997; 32(1): 71–80.

43. Baranzelli MC, Patte C, Bouffet E. Carboplatin-based chemotherapy (CT) and focal radiation (RT) in primary cerebral germ cell tumors (GCT): A French Society of Pediatric Oncology (SFOP) experience. Proc Am Soc Clin Oncol 1999; 18: 140A.

44. Calaminus G, Bamberg M, Harms D et al. AFP/beta–HCG secreting CNS germ cell tumors: Long-term outcome with respect to initial symptoms and primary tumor resection. Results of the cooperative trial MAKEI 89. Neuropediatrics 2005; 36(2): 71–77.

45. Calaminus G, Bamberg M, Jörgens H et al. Impact of surgery, chemotherapy and irradiation on long term outcome of intracranial malignant non-germinomatous germ cell tumors: Results of the German Cooperative Trial MAKEI 89. Klin Paediatr 2004; 216(3): 141–149.