Treatment Outcome of a β-hCG Secreting Intracranial Germ Cell Tumor in an Adult Filipino using Definitive Chemotherapy followed by Radiotherapy: A Case Report

Florence Rochelle Gan; Maria Honolina Gomez; Julie Ann Tapispisan

doi:10.15605/jafes.037.01.12

Authors

Florence Rochelle Gan University of Santo Tomas Hospital, Manila, Philippines https://orcid.org/0000-0001-5256-8018
Maria Honolina Gomez University of Santo Tomas Hospital, Manila, Philippines
Julie Ann Tapispisan University of Santo Tomas Hospital, Manila, Philippines https://orcid.org/0000-0003-4383-7997

DOI:

https://doi.org/10.15605/jafes.037.01.12

Keywords:

Germ cell tumors (GCTs), germinoma, β hCG, hypopituitarism, diabetes insipidus

Abstract

We report a case of a 24-year-old Filipino male who complained of general weakness, polydipsia, weight loss, bitemporal headaches, loss of libido and behavioral changes. Endocrine work-up revealed neurogenic diabetes insipidus and panhypopituitarism. Brain MRI showed multiple intracranial tumors in the left frontal lobe, pineal and suprasellar region with moderate non-communicating hydrocephalus. Intracranial mass biopsy with ventriculo-peritoneal shunting was done. Histopathology of the mass and CSF revealed a germinoma. He underwent chemoradiotherapy while on maintenance hormone replacement.

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Author Biographies

Florence Rochelle Gan, University of Santo Tomas Hospital, Manila, Philippines

Section of Endocrinology, Diabetes and Metabolism

Maria Honolina Gomez, University of Santo Tomas Hospital, Manila, Philippines

Section of Endocrinology, Department of Medicine

Julie Ann Tapispisan, University of Santo Tomas Hospital, Manila, Philippines

Section of Oncology

References

Echevarría ME, Fangusaro J, Goldman S. Pediatric central nervous system germ cell tumors: A review. Oncologist. 2008;13(6):690-9. https://pubmed.ncbi.nlm.nih.gov/18586924. https://doi.org/10.1634/theoncologist.2008-0037

Makino K, Nakamura H, Yano S, Kuratsu J, Kumamoto Brain Tumor Group. Population-based epidemiological study of primary intracranial tumors in childhood. Childs Nerv Syst. 2010;26(8):1029-34. https://pubmed.ncbi.nlm.nih.gov/20349186. https://doi.org10.1007/s00381-010-1126-x.

Wong TT, Ho DM, Chang KP, et al. Primary pediatric brain tumors: Statistics of Taipei VGH, Taiwan (1975-2004). Cancer. 2005;104(10):2156-67. https://pubmed.ncbi.nlm.nih.gov/16220552. https://doi.org/10.1002/cncr.21430.

Cho KT, Wang KC, Kim SK, Shin SH, Chi JG, Cho BK. Pediatric brain tumors: Statistics of SNUH, Korea (1959-2000). Childs Nerv Syst. 2002;18(1-2):30-7. https://pubmed.ncbi.nlm.nih.gov/11935241. https://doi.org/10.1007/s00381-001-0547-y.

Villano JL, Virk IY, Ramirez V, Propp JM, Engelhard HH, McCarthy BJ. Descriptive epidemiology of central nervous system germ cell tumors: Nonpineal analysis. Neuro Oncol. 2010;12(3):257-64. https://pubmed.ncbi.nlm.nih.gov/20167813. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2940596. https://doi: 10.1093/neuonc/nop029.

Rickert CH, Paulus W. Epidemiology of central nervous system tumors in childhood and adolescence based on the new WHO classification. Childs Nerv Syst. 2001;17(9):503-11. https://pubmed.ncbi.nlm.nih.gov/11585322. https://doi.org/10.1007/s003810100496.

De Leon JA, Khu KO. Five-year review of pineal region tumors at the Philippine General Hospital. Philipp J Surg Spec. 2017;72(1):12-9.

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. https://pubmed.ncbi.nlm.nih.gov/17618441. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1929165. https://doi.org/10.1007/s00401-007-0243-4.

Bromberg JE, Baumert BG, de Vos F, Gijtenbeek JM, Kurt E, Westermann AM. Primary intracranial germ-cell tumors in adults: A practical review. J Neurooncol. 2013;113(2):175-83. https://pubmed.ncbi.nlm.nih.gov/23526409. https://doi.org/10.1007/s11060-013-1114-6.

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):446-55. https://pubmed.ncbi.nlm.nih.gov/9046301. https://doi.org/10.3171/jns.1997.86.3.0446

Sethi RV, Marino R, Niemierko A, Tarbell NJ, Yock TI, MacDonald SM. Delayed diagnosis in children with intracranial germ cell tumors. J Pediatr. 2013;163(5):1448-53. https://pubmed.ncbi.nlm.nih.gov/23896184. https://doi.org/10.1016/j.jpeds.2013.06.024.

Crawford JR, Santi MR, Vezina G, Myseros JS, Keating RF, LaFond DA, et al. CNS germ cell tumor (CNSGCT) of childhood: Presentation and delayed diagnosis. Neurology. 2007;68(20):1668-73. https://pubmed.ncbi.nlm.nih.gov/17502547. https://doi.org/10.1212/01.wnl.0000261908.36803.ac.

Osorio DS, Allen JC. Management of CNS germinoma. CNS Oncol. 2015;4(4):273-9. https://pubmed.ncbi.nlm.nih.gov/26118663. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6088312. https://doi.org/10.2217/cns.15.13.

Kamoshima Y, Sawamura Y. Update on current standard treatments in central nervous system germ cell tumors. Curr Opin Neurol. 2010;23(6):571-5. https://pubmed.ncbi.nlm.nih.gov/20885323. https://doi.org/10.1097/WCO.0b013e32833ff522.

Jorsal T, Rørth M. Intracranial germ cell tumours. A review with special reference to endocrine manifestations. Acta Oncol. 2012;51(1):3-9. https://pubmed.ncbi.nlm.nih.gov/22150165. https://doi.org/10.3109/0284186X.2011.586000.

Yang WP, Chien HY, Lin YC. β-human chorionic gonadotropin-secreting intracranial germ-cell tumor associated with high testosterone in an adult man: A case report. Oncol Lett. 2017;14(1):1129-32. https://pubmed.ncbi.nlm.nih.gov/28693284. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5494684. https://doi.org/10.3892/ol.2017.6213.

Nagi DK, Jones WG, Belchetz PE. Gynaecomastia caused by a primary mediastinal seminoma. Clin Endocrinol (Oxf). 1994;40(4):545-8. https://pubmed.ncbi.nlm.nih.gov/7514514. https://doi.org/10.1111/j.1365-2265.1994.tb02496.x.

Lefebvre H, Laquerriere A, Cleret JM, Kuhn JM. A hCG-secreting testicular seminoma revealed by male infertility: Mechanism of hCG-evoked endocrine disturbances. Andrologia. 1993;25(5):283-7. https://pubmed.ncbi.nlm.nih.gov/8250292. https://doi.org/10.1111/j.1439-0272.1993.tb02726.x.

Djaladat H, Nichols C, Daneshmand S. Androgen-producing testicular germ cell tumors. J Clin Oncol. 2011;29(21):e634-5. https://pubmed.ncbi.nlm.nih.gov/21606422. https://doi.org/10.1200/JCO.2011.35.1965.

Tian C, Shi Q, Pu C, et al. Re-evaluation of the significance of cerebrospinal fluid human chorionic gonadotropin in detecting intracranial ectopic germinomas. J Clin Neurosci. 2011;18(2):223-6. https://pubmed.ncbi.nlm.nih.gov/21163658. https://doi.org/10.1016/j.jocn.2010.04.041.

Kortmann RD. Current concepts and future strategies in the management of intracranial germinoma. Expert Rev Anticancer Ther. 2014;14(1):105-19. https://pubmed.ncbi.nlm.nih.gov/24224870. https://doi.org/10.1586/14737140.2014.856268.

Bamberg M, Kortmann RD, Calaminus G, et al. Radiation therapy for intracranial germinoma: Results of the German cooperative prospective trials MAKEI 83/86/89. J Clin Oncol. 1999;17(8):2585-92. https://pubmed.ncbi.nlm.nih.gov/10561326. https://doi.org/10.1200/JCO.1999.17.8.2585.

Fetcko K, Dey M. Primary central nervous system germ cell tumors: A review and update. Med Res Arch. 2018;6(3):1719. https://pubmed.ncbi.nlm.nih.gov/30271875. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6157918. https://doi.org/10.18103/mra.v6i3.1719.

Lim DH, Yoo KH, Lee NH, et al. Intensive chemotherapy followed by reduced-dose radiotherapy for biopsy-proven CNS germinoma with elevated beta-human chorionic gonadotropin. J Neurooncol. 2014;117(2):279-85. https://pubmed.ncbi.nlm.nih.gov/24488445. https://doi.org/10.1007/s11060-014-1381-x.

Kellie SJ, Boyce H, Dunkel IJ, et al. Primary chemotherapy for intracranial nongerminomatous germ cell tumors: Results of the second international CNS germ cell study group protocol. J Clin Oncol. 2004;22(5):846-53. https://pubmed.ncbi.nlm.nih.gov/14990640. https://doi.org/10.1200/JCO.2004.07.006.

da Silva NS, Cappellano AM, Diez B, et al. Primary chemotherapy for intracranial germ cell tumors: Results of the third international CNS germ cell tumor study. Pediatr Blood Cancer. 2010;54(3):377-83. https://pubmed.ncbi.nlm.nih.gov/20063410. https://doi.org/10.1002/pbc.22381.

Calaminus G, Frappaz D, Kortmann RD, et al. Outcome of patients with intracranial non-germinomatous germ cell tumors-lessons from the SIOP-CNS-GCT-96 trial. Neuro Oncol. 2017;19(12):1661–72. https://pubmed.ncbi.nlm.nih.gov/29048505. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5716085. https://doi.org/10.1093/neuonc/nox122.

Calaminus G, Kortmann R, Worch J, et al. SIOP CNS GCT 96: Final report of outcome of a prospective, multinational nonrandomized trial for children and adults with intracranial germinoma, comparing craniospinal irradiation alone with chemotherapy followed by focal primary site irradiation for patients with localized disease. Neuro Oncol. 2013;15(6):788-96. https://pubmed.ncbi.nlm.nih.gov/23460321. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3661100. https://doi.org/10.1093/neuonc/not019.

Lee JH, Woo IS, Cho YY, et al. Successful treatment of intracranial germ cell tumor: Report of two unusual cases and literature review. Case Rep Oncol. 2015;8(3):520-5. https://pubmed.ncbi.nlm.nih.gov/26668575. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4677715. https://doi.org/10.1159/000441837.

Wong J, Goddard K, Laperriere N, et al. Long term toxicity of intracranial germ cell tumor treatment in adolescents and young adults. J Neurooncol. 2020;149(3):523-532. https://pubmed.ncbi.nlm.nih.gov/33034840. https://doi.org/10.1007/s11060-020-03642-1.

Bolocan A, Socea B, Paduraru DN, et al. Pineal germinoma – hypogonadism issues. Arch Balk Med Union. 2019;54(4): 771-5. https://doi.org/10.31688/ABMU.2019.54.4.25.