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PubMed1998

Possible common origin of alpha-fetoprotein- and human chorionic gonadotropin--secreting cells in intracranial germ cell tumor. Case report.

A primary intracranial germ cell tumor in a 16-year-old boy secreted both alpha-fetoprotein (AFP) and human chorionic gonadotropin (HCG). The tumor, located in the right thalamus, contained germinomatous, trophoblastic, and endodermal sinus components. To identify AFP- and HCG-secreting cells, germ cells from the surgical specimen were cultured in vitro. These cultured cells secreted AFP and HCG for 10 weeks, and immunohistochemical studies showed that some of the cells secreted both AFP and HCG. These findings suggest that multipotential germ cells migrate to the encephalic region and may become germ cell tumors containing various types of tissue.

Adolescent↗

PubMed1987

Comparison of fluorine-18-2-fluorodeoxyglucose and gallium-67 citrate imaging for detection of lymphoma.

Patients with lymphomas are conventionally imaged with [67Ga]citrate for tumor detection and determination of dissemination. Fluorine-18-2-fluoro-2-deoxy-D-glucose [( 18F]FDG) is a radiopharmaceutical that accumulates into tissues where glucose utilization is enhanced, such as tumors. Six cancer patients (five non-Hodgkin's lymphomas, one endodermal retroperitoneal sinus carcinoma) were imaged with [18F]FDG and [67Ga]citrate whole-body scintigraphies in order to compare the sensitivities of these two tumor imaging radiopharmaceuticals. Among the five untreated lymphoma patients, two 67Ga scans and four [18F]FDG scans were positive; in the patient with the retroperitoneal carcinoma who had a positive [18F]FDG scan before treatment, both scans were negative after treatment. Fluorine-18 FDG may be a more sensitive tumor-detecting radiopharmaceutical for non-Hodgkin's lymphoma than [67Ga]citrate.

Adult↗

PubMed1982

[Experimental induction of yolk sac tumor in rat (author's transl)].

Unlike those experiments described in the previous several reports, a carcinogen was given to pregnant rats in our experiment to induce a tumor similar to yolk sac tumor which often occurs in human cases, aiming at contribution to establishment of an experimental model. Using Wister rat on the 10th day of gestation, ater removal of the fetus, the yolk sac was extracted out of the uterus, and a carcinogen was administered to it. Induced tumor was examined morphologically. By the 16th week after experiment, tumor was induced in 70% out of rats treated. The tumor volume was varied from a bean to a thumb tippize. Histologically, most of them were considered to be teratoma. But in 30% of them, human pure-type yolk sac tumor or the tumor similar to it were observed. Reticular and endodermal sinus or polyvesicular vitelline patterns were also clearly observed. Presence of hyaline body by PAS-staining and AFP by fluorescent antibody method were confirmed.

9,10-Dimethyl-1,2-benzanthracene↗

PubMed2001

Giant cavernous sinus teratoma: a clinical example of a rare entity: case report.

OBJECTIVE AND IMPORTANCE: Teratomas represent 0.5% of all intracranial tumors. These benign tumors have tissue representative of the three germinal layers: ectoderm, mesoderm, and endoderm. Most teratomas are midline tumors located predominantly in the sellar and pineal regions. Cavernous sinus location is very rare; only two purely intracavernous teratomas have been reported. CLINICAL PRESENTATION: A 14-year-old boy presented with a history of progressive right eye proptosis and visual acuity impairment, headaches, and a neuralgia-like facial pain in the right V1 distribution. A head computed tomographic scan and magnetic resonance imaging disclosed a large tumor filling the right cavernous sinus and extending into the ipsilateral middle fossa. These scans also demonstrated mixed signals derived from different tissues conforming to the tumor (fat, cartilage, muscle strands, bone, and a primordial tooth). Heterogeneous enhancement was seen after infusion of contrast medium. Significant bone erosion and remodeling was evident in the middle fossa floor and right orbit, with secondary proptosis. A presumptive diagnosis of mature teratoma was made. INTERVENTION: With the use of a right frontotemporal interfascial approach, a combined extra- and intradural dissection of the tumor was performed. The lesion entirely occupied the cavernous sinus, laterally displacing the Gasserian ganglion and trigeminal branches (predominantly V1 and V2). The internal carotid artery and Cranial Nerve VI were medially displaced by the tumor mass. The lesion was composed of different tissues, including hair, fat, cartilage, muscle, nerve-like tissue, bone, and a primordial tooth. The tumor was removed completely, and the pathological report confirmed the diagnosis of a mature teratoma. There was no evidence of recurrence at the 8-month follow-up examination. CONCLUSION: Because of the lesion's location in the lateral wall of the cavernous sinus, a total removal was achieved with the use of standard microsurgical techniques. Knowledge of the microanatomy is essential in treating intracavernous pathology. We present the third reported case of a giant mature teratoma of the cavernous sinus.

Adolescent↗

PubMed1983

[Human yolk sac tumor of the thymus heterotransplanted into nude mice].

A human yolk sac tumor of the thymus (YSK-1) was transplanted into athymic nude mice. Histological and ultrastructural investigations revealed that the YSK-1 tumor, even after serial transplantation in nude mice, characteristically displayed Schiller-Duval bodies, endodermal sinus structures and ultrastructural profiles, numerous microvilli, desmosome-like cell attachments, annulate lamellar structures, many lipid droplets and interspersed glycogen particles. Serological study by radioimmunoassay demonstrated AFP, CEA, HCG, alpha 1-AT and transferrin in the sera and cyst fluid of the tumor-bearing nude mice. Immunohistochemical investigation using the PAP method showed that the YSK-1 cells produced CEA, HCG, alpha 1-AT, transferrin as well as AFP. The increase in the level of AFP paralleled the increase in tumor size.

Adult↗

PubMed1996

Maturation of intracranial immature teratomas. Report of two cases.

Immature teratomas arising within the central neuraxis are rare neoplasms. These tumors contain diverse cell lineages that retain an embryonal character and display phenotypic differentiation attributed to the three classic germ layers. The clinical management of these lesions is unclear, due in part to their low incidence and to an incomplete understanding of their natural history. Although the potential for phenotypic differentiation and cellular maturation within immature teratomas arising in the gonads is well documented, this has not been described in the intracranial tumors. In the present report, the authors describe two cases of intracranial immature teratomas, one involving the pineal region and the other involving the left frontotemporal lobes, which underwent cellular differentiation and maturation. At initial resection, the tumors from both cases were composed predominantly of primitive neuroepithelial tissue that was admixed with immature and differentiating mesenchymal and epithelial structures. No foci of germinoma, endodermal sinus, choriocarcinoma, or embryonal carcinoma tissue were present. Subsequent resections in both cases revealed an absence of immature tissue. The tumor in Case 1 contained only differentiated epithelial and mesenchymal tissue with no neuroepithelial component, whereas the tumor in Case 2 demonstrated abundant mature neuronal and glial tissue. These two cases from different intracranial sites suggest that spontaneous maturation may be a significant aspect of the natural history of intracranial immature teratomas.

Brain Neoplasms↗

PubMed1988

Immunohistochemical differences between intracranial germinomas and their gonadal equivalents. An immunoperoxidase study of germ cell tumors with epithelial membrane antigen, cytokeratin, and vimentin.

Twenty-six intracranial germ cell tumours (11 germinomas, 10 teratomas, 2 endodermal sinus tumours, 1 teratocarcinoma, and 2 undifferentiated embryonal carcinomas) and 26 gonadal germ cell tumours (13 testicular seminomas, 2 ovarian dysgerminomas, 9 ovarian teratomas, and 2 myometrial choriocarcinomas) were studied by immunoperoxidase with monoclonal antibodies (MAbs) against epithelial membrane antigen (EMA), cytokeratin, and vimentin. Typical tumour cells in three of the 11 germinomas (two of the latter being situated in the posterior fossa) expressed both EMA and cytokeratin, whereas those in the seminomas and dysgerminomas did not. In one seminoma, a few multinucleated giant cells expressed cytokeratin. In three of seven germinomas, vimentin-positive tumour cells were found, but all seminomas and dysgerminomas were negative. In the other forms of intracranial and gonadal germ cell tumours, epithelial and mesenchymal elements displayed the expected patterns of immunoreactivity to the respective determinants. The immunoperoxidase differences between the intracranial germinomas and their gonadal equivalents indicate that, in the former, early epithelial or mesenchymal differentiation of the primordial germ cells may be present. The findings draw attention to the heterogeneous cellular composition of these otherwise morphologically homogeneous-appearing tumours and, especially in the posterior fossa, to their transitional links to the immature teratomas.

Adolescent↗

PubMed1993

Embryologic clues to human yolk sac tumors: a review.

Morphological similarities and differences in the developmental structure of the human yolk sac and human yolk sac tumors (HYSTs) are reviewed to determine the histogenesis of the currently recognized multiple tumoral patterns. Although many equivalent histochemical markers, secretory hyaline globules, and hemopoiesis occur in both HYSTs and the secondary human yolk sac (SHYS), few similarities are found in their comparative morphology. For example, HYSTs do not reproduce the characteristic morphology of SHYS with its large, clear cells and endodermal and intracellular tubules; basement membrane is abundant in tumors but only an inapparent and temporary structure in the SHYS; no Schiller-Duval sinuses are found in either primary or secondary human yolk sacs, and the plentiful mesenchymal (mesoblastic) components of tumors are absent in the SHYS except for the collagenous connective tissue that occurs during regression. Unlike the SHYS, which is a terminal structure incapable of polydifferentiation and only rarely develops any somatic structures, HYSTs frequently differentiate tissues of endodermal origin such as intestine, liver, and even lung. The primary human yolk sac is capable of multiple differentiation, both endodermal and possibly mesenchymal, as well as its ultimate differentiation into the SHYS with its characteristic endodermal markers. Thus, it seems more appropriate to correlate the comparative morphology of HYSTs with the primary human yolk sac, rather than the SHYS, and, in the light of this, reconsider their classification as extraembryonally differentiated tumors.

Cell Differentiation↗

PubMed1992

The unique association of malignant histiocytosis and a primary gonadal germ cell tumor.

Previous reports of the association between hematologic malignancies and germ cell tumors have been limited to patients with nonseminomatous tumors, exclusively of mediastinal origin. Among the various hematologic disorders, a large proportion have involved histiocytic tumors, either acute monocytic leukemia or malignant histiocytosis. We now report the first case of simultaneously occurring malignant histiocytosis and testicular embryonal carcinoma. The patient, an 18-year-old male, presented with hepatosplenomegaly due to malignant histiocytosis and was found on further evaluation to have a stage I testicular cancer consisting of teratocarcinoma with endodermal sinus elements. Despite aggressive chemotherapy, the patient died of malignant histiocytosis 6 months after the original diagnosis. The autopsy revealed widespread organ involvement with malignant histiocytosis and no evidence of residual germ cell tumor. This case demonstrates that germ cell tumors associated with hematologic malignancy do not arise solely in extragonadal sites.

Adolescent↗

PubMedDate not supplied

Malignant tumors of the anterior skull base.

BACKGROUND: Cancers of the paranasal sinuses or nasal cavity are the most common malignant tumors of the anterior skull base. Several types of tumors occur in this location, including cancers of endodermal, mesodermal, and epidermal origins. Although anterior skull base surgery is a relatively recent approach in treating these tumors, widespread changes have already occurred in procedural methods and treatment goals. METHODS: We review the tumor types that occur in the anterior skull base and discuss the current treatment options, including multimodal therapy and the team approach to surgery. Surgical techniques are also described. RESULTS: Management of anterior skull base cancer is complex due to the anatomic detail of the region and the variety of cancers that occur in this area. Currently, the "gold standard" for surgery is the anterior craniofacial approach. Combined with adjuvant radiation therapy, 5-year disease-free survival rates have increased to 50%, with some tumors such as adenocarcinomas and esthesioneuroblastomas reaching up to 80% 5-year survival rates. Potential complications include cerebrospinal fluid leakage, meningitis, abscess formation, and pneumocephalus. CONCLUSIONS: Treatment of anterior skull base cancer is complex due to the significant anatomic detail of the region and the variety of cancers that occur in this area. Multimodal therapy through a team approach is the optimal management approach for these tumors.

Adenocarcinoma↗

PubMed1992

[Cellular characteristics of yolk sac tumor].

Morphological analysis of imprint cytology and histology was performed in 5 patients with yolk sac tumor (YST). The age of the patients ranged from 14 to 37. The level of AFP ranged from 460 ng/ml to 13,464 ng/ml. Five patients had a primary lesion in the ovary. These five cases of YST were histologically evaluated and classified into 4 patterns. As a result, the endodermal sinus pattern was the most frequently identified, followed by the polyvesicular vitelline pattern. As with imprint cytology findings in 4 YST cases, cuboidal cells were the most frequently observed; cuboidal cells and nuclei were both cuboidal in shape and 25-40 mu and 20-25 mu in diameter respectively. The chromatin had fine to coarse granular patterns. The nuclear.cytoplasmic (N/C) ratio was 50-70%, and each nucleus contained one to four nucleoli. Next to cuboidal cells, spindle-shaped cells were most frequently noticed; 20-40 mu in size with spindle-shaped nuclei 10-20 mu in diameter and had a fine to coarse granular chromatin pattern. The nuclei of the 30-50% N/C ratio cells contained one to two nucleoli. Naked cells and bizarred cells were also noticed.

Adolescent↗

PubMed1996

[Doppler ultrasonography diagnosis of right ventricular outflow tract obstruction caused by mediastinal tumor and its reversibility after treatment].

Doppler-echocardiography has proved useful in the assessment of mediastinal masses. We present the case of a young man with fever and new systolic murmur. Echocardiographic examination revealed a paracardiac mass compressing the right ventricular outflow tract and Doppler flow study detected marked acceleration in luminal narrowing. Complete remission of the tumour was obtained with subtotal resection and chemotherapy. Histological diagnosis was of embryonary carcinoma with areas of endodermic sinus. A new Doppler-echocardiography study showed disappearance of both the mass and the compression and showed normal right ventricular outflow tract flow.

Adult↗

PubMedDate not supplied

[Current treatment of malignant ovarian germ cell tumors].

Thirty-two patients were treated for ovarian germ cell malignomas, first, along with surgery, with a combined chemotherapy (vincristine, actinomycin D, cyclophosphamide) up to 18 treatments and later up to 6 treatments, except in immature teratomas and advanced cases. At present, in the third stage of the disease a new protocol is applied: cis-platinum, vinblastine, and bleomycin. Four patients with dysgerminoma were surgically treated (two were subsequently irradiated). Only two patients died--one with an endodermal sinus tumour and one with a mixed malignoma, both in the third stage of the disease. The remaining patients are alive and feel well. Except for three, all of them have been followed up for more than five years.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed1997

[Management of stage I testicular nonseminomatous germ cell tumors with an embryonic carcinomatous component. 18 cases].

OBJECTIVE: To evaluate the prognosis and therapeutic modalities of stage I nonseminomatous germ cell tumours of the testis (NSGT) with an embryonic carcinomatous component (EC). MATERIAL AND METHODS: 18 patients with stage I nonseminomatous germ cell tumour of the testis with an embryonic carcinomatous component were treated between 1987 and 1995. EC represented more than 50% of the testicular tumour mass in 15 cases. This tumour contingent constituted the only potential prognostic factor in 4 cases, but vascular or lymphatic emboli (n = 3), tumour stage > pT1 (n = 5) or absence of endodermal sinus component (n = 9) were observed in 14 cases. The first 3 patients underwent retroperitoneal lymph node dissection and the following 15 patients were submitted to surveillance (n = 4) or chemotherapy (n = 11) according to the PVB [Cisplatin, Vinblastine, Bleomycin] (n = 7) or BOE [bleomycin, Etoposide, Cisplatin] (n = 4) protocols. RESULTS: With a follow-up of 10 to 110 months (mean: 46), the survival rate is 100% and the recurrence rate is 22%. None of the patients with a local stage exceeding pT1 relapsed after chemotherapy. 2 patients in whom the EC contingent represented less than 50% of the tumour mass and who were simply watched, did not relapse. 4 relapses, detected 3 to 14 months after orchidectomy (mean: 8.5), during surveillance (n = 2) or after chemotherapy (n = 2), required surgical resection or complementary chemotherapy. They occurred in patients in whom EC represented more than 50% of the testicular lesion. The tumour of initially conservatively managed patients did not contain an endodermal sinus component (n = 2) or presented vascular emboli (n = 1). The subjects treated by chemotherapy were characterized by the presence of emboli (n = 1) or the absence of endodermal sinus component (n = 1). The course after recurrence was favourable in 3 cases and the last patient is currently receiving chemotherapy. CONCLUSION: EC is an independent risk factor whose presence justifies proposal of complementary treatment by retroperitoneal lymph node dissection or chemotherapy, possibly limited to 2 courses of BOE. Surveillance can only be considered in the case of a minority of EC in the tumour, in the absence of any associated risk factors.

Adolescent↗

PubMed1988

Vitronectin production by human yolk sac carcinoma cells resembling parietal endoderm.

Normal mesenchymal cells, normal epithelial cells and many transformed epithelial cells require serum attachment factors and extracellular matrix proteins for growth and differentiation in vitro, and recent evidence strongly supports a role for extracellular matrix molecules in the regulation of cell movement in vivo during early embryogenesis. We previously described the isolation and characterization of cell lines representative of three types of stem cells most commonly found in human adult testicular teratomas, namely embryonal carcinoma cells, yolk sac carcinoma cells resembling visceral endoderm and yolk sac carcinoma cells resembling parietal endoderm (endodermal sinus tumour cells). Of these three cell types, only endodermal sinus tumour cells, which show particularly malignant behaviour in vivo, have no serum requirement for attachment and growth in vitro. Supernatants from endodermal sinus tumour cells support the attachment of embryonal carcinoma cells in serum-free medium. We demonstrate here that endodermal sinus tumour cells, but not other cell types isolated from testicular teratomas, secrete the serum attachment protein, vitronectin (also known as serum-spreading factor, S-protein or epibolin), as well as fibronectin, laminin and type IV collagen, into serum-free medium. Purified vitronectin from medium conditioned by endodermal sinus tumour cells supported both attachment and spreading of embryonal carcinoma cells in vitro, whereas cells attached but did not spread properly on surfaces coated with fibronectin or laminin. Peptides containing the RGD cell recognition sequence common to many attachment proteins blocked attachment of endodermal sinus tumour cells to untreated tissue-culture plastic in serum-free medium. The results suggest a possible role for vitronectin in regulating cell motility and growth in early development, and in the invasion and spread of teratomas in vivo.

Collagen↗

PubMed1979

Malignant presacral teratoma in children.

Malignant presacral teratoma is a rare tumor seen predominantly in young female children. The introduction of planned multidisciplinary treatment has improved the outlook for patients with this once dismal disease. Six female children were seen at Memorial Hospital with the diagnosis of malignant presacral teratoma. Five children were age 17 mo to 3 yr and the sixth child was 13 yr old at diagnosis. Presenting symptoms included masses in the buttock or groin, constipation, difficulty voiding, and local pain. Pathological features were varied and complex but three had predominantly endodermal sinus features. One child had the malignant presacral teratoma develop 18 mo after successful resection of a benign sacrosoccygeal teratoma in the newborn period. Treatment varied in the six cases since all were referred after failure of treatment elsewhere. All children had surgery, irradiation, and multiple drug chemotherapy. Four of the six children are surviving disease-free, 3 more than 24 mo off treatment. Evolution of treatment up to the present protocol management is discussed.

Antineoplastic Agents↗

PubMed1988

Analysis of cell-differentiation lineage in human teratomas using new monoclonal antibodies to cytostructural antigens of embryonal carcinoma cells.

Human embryonal carcinoma cells sometimes display the developmental potential of early embryonic stem cells. While available data do not clearly identify a counterpart of these tumor cells in normal development, previous comparisons of human embryonal carcinoma and yolk sac carcinomas indicated that these cell types are closely related, and suggested that embryonal carcinoma cells might resemble the progenitors of extraembryonic endoderm. To analyse further cell-differentiation lineage in these tumors, we produced monoclonal antibodies to cytostructurally associated antigens of human embryonal carcinoma cells. Spleen cells from mice immunized with a detergent-insoluble extract of cultured human embryonal carcinoma cells were fused to NS-1 myeloma cells, and hybridoma supernatants were screened by indirect immunofluorescence on the immunizing cell line, then on a panel of cell lines derived from human embryonal carcinomas, yolk sac carcinomas, and a range of neoplastic and normal tissues. Monoclonal antibody GCTM-1 stained the nuclei of all human cells tested and served as a positive control; this antibody immunoprecipitated proteins of 85 and 66 k Da from human embryonal carcinoma cells. GCTM-2 recognized an epitope on a 200-k Da extracellular protein present on the surface of embryonal carcinoma cells, and stained the surface of visceral yolk sac-type carcinoma and colorectal carcinoma cells as well. Enzymatic analysis of carbohydrate residues on the GCTM-2 antigen revealed that it was a keratan sulphate proteoglycan, and suggested that the epitope recognized by the antibody lies on the core protein. In immunoblots, antibody GCTM-3 bound to a 57-k Da cytoskeletal protein expressed in human embryonal carcinoma. This antibody decorated filamentous arrays in cell lines from human embryonal carcinoma, visceral yolk sac carcinoma, parietal yolk sac carcinoma (endodermal sinus tumour), and adenocarcinoma and large cell carcinoma of the lung. Antibody GCTM-4 recognized a determinant present on a 69-k Da polypeptide, associated with a component of the lysosomal compartment, which was expressed in embryonal carcinoma cells, but no other cell type tested. The results with this antibody panel thus allow distinction between human embryonal carcinoma and yolk sac carcinoma, but provide further evidence of a close relationship between these cell types.

Animals↗

PubMed1983

Therapy of extragonadal germ-cell tumors.

Sixteen patients with primary extragonadal germ-cell tumors were treated at the Department of Chemotherapy, Finsen Institute, Copenhagen from 1976 to 1982. Twelve patients received a combination of cis-diamminedichloroplatinum (cisplatin), vinblastine and bleomycin (PVB). Eight patients had a complete remission and 5 had a partial response. Eighty-six percent of the patients achieving complete remission remain free of disease after a median follow-up of 42 months. The best results with PVB were obtained in teratocarcinomas and embryonal carcinomas, while more effective chemotherapy regimens are needed for the treatment of choriocarcinomas and endodermal sinus tumours.

Adult↗