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An eight-year-old child presenting with increased thirst, raised intracranial tension and visual deterioration was diagnosed with synchronous suprasellar and pineal lesions, for which she underwent partial resection of the suprasellar lesion. Histopathological examination suggested pure germinoma. Tumor marker evaluation showed significantly raised levels of beta human chorionic gonadotropin (βHCG), favoring a non-germinoma germ cell tumor (NGGCT), leading to a diagnostic dilemma as the histology and βHCG levels were contradictory. Giving cognizance to the tumor marker levels, the treatment was designed on the lines of NGGCT. Planning of radiotherapy including craniospinal irradiation (CSI) and boost to both lesions was once again a challenge, given the proximity of the lesions to vital organs at risk (OAR). Given the child's age and location of lesions, the target volumes and doses of radiation were designed to optimize between the goals of achieving long-term local control and minimizing late-onset toxicities. [ABSTRACT FROM AUTHOR]

We present the first and a rare case of orthotopic renal auto-transplantation in the management of postchemotherapy residual retroperitoneal mass encasing the left renal vessels but sparing the parenchyma in a 24-year-old patient with Stage IIIC nonseminomatous germ cell tumor after 4 cycles of chemotherapy. Immediate postoperative and 6 months' follow-up renograms confirmed the maintained glomerular filtration rate of the transplanted kidney with no residual disease. This case report shows the feasibility of renal autotransplantation in carefully selected patients as they are young and have long-term survival. [ABSTRACT FROM AUTHOR]

Introduction: Chemotherapy, postchemotherapy retroperitoneal lymph node dissection (pcRPLND), and metastasectomy remain the standard of care for the management of advanced nonseminomatous germ cell tumor (NSGCT). Methods: We retrospectively studied 73 patients who had pcRPLND at a single tertiary-care center (2003-2022). Surgical and clinicopathological features and oncological outcomes are presented. Results: The mean age was 28.27 years (15-48). Three-fourths had Stage III disease at diagnosis. International Germ Cell Cancer Collaborative Group risk stratification was 54.54% and 21.21% in intermediate risk, and poor risk, respectively. Sixty-two patients had Standard, 7 had Salvage and 4 underwent Desperation pcRPLND. Eleven patients (15.06%) required adjunctive procedures. Thirteen patients (17.8%) had ≥ class 3 Clavien--Dindo complications and postoperative mortality occurred in 5 (6.8%) patients. The histopathologies (HPE) of the pcRPLNDs were necrosis, teratoma, and viable tumor in 39.7%, 45.2%, and 15.1%, respectively. Seven patients underwent metastasectomy. An 85% size reduction in the size of RPLN predicted necrosis. There was 71.4% concordance between pcRPLND and metastasectomy HPEs. The median follow-up was 26.72 months (inter-quartile range -- 13.25-47.84). The 2-year recurrence-free survival (RFS) rate was 93% (95% confidence interval [CI]-83%-97%) and the overall survival (OS) rate was 90% (95% CI-80%-95%). This is the largest series of pcRPLND for NSGCT in India to our knowledge. Conclusion: Although most of the cohort belonged to stage III, an RFS and OS rate of >90% at 2 years was achieved. We believe that successful management of postchemotherapy residual masses in NSGCT is contingent on the availability of multidisciplinary expertise and is therefore best done at tertiary-care referral centers. [ABSTRACT FROM AUTHOR]

Germ cell tumor of the central nervous system (CNS) is an infrequent entity consisting of only 0.2%–1.7% of all primary CNS tumors. The pineal gland is the commonest location of CNS germinoma. Traditionally, radiotherapy alone has been used to treat localized pineal germinoma, which has delivered a very high cure rate. Spinal drop metastases from pineal germinoma can develop after a long time from diagnosis and primary treatment. Currently, craniospinal irradiation is the standard of care in metastatic pineal germinoma with spinal drop metastases along with systemic chemotherapy. Very few cases of pineal germinoma with spinal drop metastases have been published in the literature. We report a pineal gland germinoma case with spinal drop metastases in an 18-year-old boy and reviewed the published literature. [ABSTRACT FROM AUTHOR]

Extragonadal germ cell tumors (GCTs) are challenging to diagnose. We present a case of suprarenal GCT, with hepatic infiltration where differential diagnosis included neuroblastoma and hepatoblastoma. The positive positron emission tomography scan further obfuscated the situation. The diagnosis was clinched by fine-needle aspiration cytology and cell block immunohistochemistry. [ABSTRACT FROM AUTHOR]

Background and Objective: Primary intracranial germ cell tumors (ICGCTs) are rare and are histologically classified as germinomas and non‑germinomatous with distinctive prognostic and therapeutic implications. ICGCTs, essentially due to the inherent difficulty of surgical access, pose different challenges and management connotations than their extracranial counterparts. This is a retrospective analysis of histologically verified ICGCTs, which was undertaken to evaluate various clinicopathological features and their implications on patient management. Materials and Methods: Eighty‑eight histologically diagnosed cases (over 14 years) of ICGCT at our institute formed the study cohort and were classified into germinoma and non‑germinomatous germ cell tumors (NGGCTs). Additionally, germinomas were further subdivided on the basis of 1) tumor marker (TM) levels, as germinoma with normal TM, mildly elevated TM, and markedly elevated TM and 2) radiology features, as germinomas with typical radiology and atypical radiological features. Results: ICGCT with age ≤6 years (P = 0.049), elevated TM (P = 0.047), and NGGCT histology (P < 0.001) showed significantly worse outcomes. Furthermore, germinomas with markedly elevated TM and certain atypical radiological features showed prognosis akin to NGGCT. Conclusions: Analysis of our largest single cancer center Indian patient cohort of ICGCT shows that inclusion of age ≤6 years, raised TM, and certain radiological features may assist clinicians in overcoming the limitations of surgical sampling, with better prognostication of histologically diagnosed germinomas. [ABSTRACT FROM AUTHOR]

A rare extragonadal mixed germ cell tumor of the sacrococcygeal area presenting with mature thymic tissue in the teratomatous component, a rare finding and the first reported case of such an association. [ABSTRACT FROM AUTHOR]

Primary sarcoma of the ovary is extremely rare. There are inadequate data in the literature regarding ovarian sarcoma in the pediatric age group. We report a case of an 8-year-old girl presenting with large abdominal mass and cachexia. Raised alpha-fetoprotein levels suggested germ cell tumor. Tru-cut biopsy histopathological report suggested a spindle cell tumor. The IHC staining suggested non rhabdomyosarcoma. As tumour was large and ovarian pediatric non rhabdomyosarcoma was not reported in the literature, we started on rhabdomyosarcoma neoadjuant regimen. Good response was noted for neoadjuvant chemotherapy, which was followed by complete surgical excision of the tumor and radiotherapy. At present, the overall outcome of the disease is dismal. Increased available data and gaining more evidence may help in improvising the treatment option. [ABSTRACT FROM AUTHOR]

Aims: The study aimed to evaluate the presentation, management, and outcome of patients of sacrococcygeal malignant germ cell tumors (SC-MGCTs) with intraspinal extension. Materials and Methods: Case records of all cases of SC-MGCT were reviewed to identify cases with intraspinal extension. They were evaluated in terms of their presentation, response to therapy, extent of surgical resection, recovery of neurological symptoms if any, and outcome. Results: Of the three cases of SC-MGT, two had intraspinal extension. One had Altman Type 3 disease and another had Altman Type 4 disease; both had Stage 4 disease. The intraspinal extension in both patients was detected on contrast computed tomography scan and magnetic resonance imaging. One patient had bladder and bowel incontinence. All the tumors responded to preoperative chemotherapy. Gross complete local resection could be achieved in all patients. Neurological recovery was complete. All were alive with no recurrence on follow-up. Conclusions: Malignant sacrococcygeal GCTs with intraspinal extension are rare and can be managed with neoadjuvant chemotherapy which obviates the need for extensive exploration for excision and has got good neurological and oncological prognosis. [ABSTRACT FROM AUTHOR]

Epithelioid trophoblastic tumor is an extremely rare tumor which occurs in women of the reproductive age group following a previous gestation. Its occurrence in male patients is remarkably rare, with only six cases reported in the English literature. Herein, we discuss the unusual occurrence of this tumor in a 31-years-old male patient as a component of non-seminomatous germ cell tumor. It presented as retroperitoneal metastasis with associated testicular microlithiasis (regressed germ cell tumor). [ABSTRACT FROM AUTHOR]

Background: Cancer is one of the leading causes of death in the pediatric age group following infections. Among the diagnostic modalities, fine needle aspiration cytology (FNAC) is increasingly recognized as it permits rapid diagnosis with low cost and complication. In this study, we emphasize the diagnostic value of FNAC and describe the cytomorphological spectrum of tumors diagnosed on FNAC in pediatric patients with or without the aid of ancillary tests. Materials and Methods: This retrospective study included a total of 614 patients under the age of 15 years for whom fine needle aspiration (FNA) was done during a period of 3 years with or without guidance. The cytology smears were reviewed, and the morphological spectrum was analyzed with the ancillary studies. Results: Aspirates from children constituted around 3.5% of the total FNAC performed in our Institute. Of the 614 cases, 336 were male, and 278 were female with age under 15 years. Neoplastic cases constituted around 72%, which included benign (2%) and malignant (98%) tumors. The spectrum include hematolymphoid neoplasms in 39.3%, small round cell tumors (SRCT) in 24.9%, Wilms tumor in 9.2%, germ cell tumors in 4.8%, spindle cell neoplasms in 4.8%, hepatoblastoma in 3.2%, and osteosarcoma in 3% of the cases. The metastatic lesions constituted 8.1% of the cases diagnosed by FNA. Conclusion: FNA proves to be a reliable and efficien modality in diagnosing pediatric neoplasms in the hands of a skilled cytopathologist. [ABSTRACT FROM AUTHOR]

Primary malignancies of the seminal vesicles are rare. Presentation of extragonadal germ cell tumor in the seminal vesicle is even rarer. We report a case of a 26-year-old male who presented with hematuria and lower urinary tract symptoms, which on imaging turned out to be a right seminal vesicle mass. The diagnosis of mixed germ cell tumor with yolk sac tumor and teratoma was made on the initial evaluation by transrectal ultrasound-guided biopsy which showed the characteristic histomorphology and immunohistochemistry profile. The patient underwent chemotherapy followed by radical pelvic exenteration. The patient is doing well with no evidence of distant metastasis in positron emission tomography/computed tomography of 1-year posttreatment. [ABSTRACT FROM AUTHOR]

Background: Primary suprasellar central nervous system lymphoma (PCNSL) of the hypothalamus is a rare entity.Material and Methods: We report a case of a 49-year-old, healthy male presented with features of diabetes insipidus. Imaging features showed a mass in the suprasellar region involving the hypothalamus mainly tuber cinereum and infundibulum.Results: Preoperative fluorodeoxyglucose (FDG) positron emission tomography-computed tomography (PET-CT) showed increased uptake in the mass. Biopsy revealed a diffuse type-B PCNSL. The present case emphasizes the importance of considering the diagnosis of hypothalamic lymphoma and the utility of FDG PET-CT in such situations.Conclusion: To our knowledge, only eight cases of suprasellar hypothalamic PCNSL have been reported in the literature. [ABSTRACT FROM AUTHOR]

Purpose: Intracranial germ cell tumors (ICGCTs) comprise approximately 0.4%–3% of all brain tumors. In this study, we aim to evaluate clinical characteristics, treatment and outcomes of patients with ICGCT. Patients and Methods: All patients with ICGCT diagnosed in Hacettepe University's Pediatric Oncology Department between January 1980 and January 2016 were evaluated, retrospectively. Results: We identified 52 patients (male/female: 2.46) diagnosed with ICGT. Median age was 140 months. The median duration of symptoms was 3 months. Patients with endocrine symptoms were diagnosed later than others (P = 0.028). The primary site was pineal region in 20 patients, nonpineal region in 32 which included six bifocal involvements. Pineal location was more common in boys than girls (P = 0.02). Histopathological diagnosis was germinoma in 28 patients, nongerminomatous malignant germ cell tumors in 14 and immature teratoma in 4. The mean age for germinoma was higher than that of nongerminomatous tumors (P = 0.032). Patients treated with surgery and radiotherapy and chemotherapy. Median follow-up time was 52.5 months. Thirty-six patients were alive for 12–228 months. Relapsed/progressive disease was observed in 11 patients. Nongerminomatous tumors more frequently showed relapse/progression than germinoma (P = 0.06). Five-year overall and event-free survival rates for the whole group were 72.6% and 57.2%, respectively. Overall and event-free survival rates for germinoma were better than malignant nongerminomatous tumors. Conclusion: Although the ratio of ICGCTs to central nervous system tumors in our series was similar to western countries, some clinical features such as tumor location were similar to cases from East Asian countries. Although similar protocols were used survival rates lower than developed western and eastern developed countries. [ABSTRACT FROM AUTHOR]

Introduction: Postchemotherapy retroperitoneal lymph node dissection (PC-RPLND) and metastasectomy play an important role in the management of advanced-stage nonseminomatous germ cell tumors (NSGCT). We aimed to analyze preoperative parameters that could predict postoperative histology. Materials and Methods: We analyzed the data of 72 patients who underwent PC-RPLND and 14 patients who underwent metastasectomy after receiving cisplatin- or carboplatin-based chemotherapy for advanced stage NSGCT at our institute from 1994 to 2015. Clinical and pathological parameters such as the histology of orchidectomy, RPLND and metastasectomy, serum tumor markers, and the pre and post chemotherapy retroperitoneal lymph node size were recorded. Results: Seventy-two patients with a mean age of 28 years underwent PC-RPLND. Of the various variables evaluated, only percentage change in nodal size was found to be statistically significant in predicting necrosis (P = 0.004). A decrease of 75% was found to predict the necrosis with a specificity of 100%. There was 84.6% concordance between the histology of RPLND and that of metastasectomy. Conclusion: A 75% reduction in tumor size is highly predictive of absence of viable tumor or teratoma, however larger series are required to confirm these findings. RPLND histopathologies have a high concordance with metastasectomy histology and thus can be used as a guide to tailor further management. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 17-year-old male patient who developed gait ataxia, diminution of vision and cranial nerve palsy through difficulty in swallowing. He had moderate sensorineural hearing loss in the right ear after examination. The patient was diagnosed with pontomedullary germinoma with suprasellar and spinal metastasis.

Introduction: We aimed to evaluate the surgical feasibility, complication, and oncological outcome of robot-assisted retroperitoneal lymph node dissection (RA-RPLND) in patients of testicular tumor with postchemotherapy residual retroperitoneal mass. Methods: A total of 13 patients underwent RA-RPLND between January 2012 and September 2016 at our institute. A study was started on December 2015, so data were collected retrospectively and prospectively regarding patient demography, tumor characteristics, surgical, pathological outcome, and oncological outcome. Results: RA-RPLND was successfully completed in all the 13 patients. Lateral approach was used in initial 12 patients with unilateral dissection in 11 patients and bilateral dissection after in 1 patient after repositioning in bilateral position. Supine robotic approach used in 1 patient. Median operative time was 200 min, median estimated blood loss was 120 ml, and median length of hospital stay was 4 days. The median yield of lymph node was 20. Three patients had positive lymph nodes, all had teratoma germ cell tumor. Ten patients had only necrosis in lymph nodes. After median follow-up 23 months (range 3-58 months), no systemic or retroperitoneal recurrence was found. Four patients developed chyle leak. One patient was managed conservatively with diet modification, one with intranodal lipiodol lymphangiography and two patients were managed surgically. Conclusion: RA-RPLND is safe and feasible for postchemotherapy residual mass with accepted compilation rate, but larger studies are required to establish its diagnostic and therapeutic utility along with safety of the procedure. [ABSTRACT FROM AUTHOR]

Testicular tumors are rare in children but highly treatable and usually curable. Seminomas are extremely rare in prepubertal children. Among nonseminomatous germ cell tumors, the most common are teratomas and yolk sac tumors. Mixed germ cell tumor (MGCT) contains more than one germ cell component. MGCT is very rare in prepubertal age group. Here, we are presenting a case of MGCT in a newborn child with a review of literature. It is the first reported case in the world literature. [ABSTRACT FROM AUTHOR]

Adjuvant treatment options for Stage I seminoma include active surveillance, chemotherapy, and radiotherapy. Active surveillance may not be ideal for the average Indian patient. Of the two accepted adjuvant therapy options, namely single-dose carboplatin chemotherapy and radiotherapy to the retroperitoneal nodes, though it intuitively appears more appealing, a deeper review reveals the potential drawbacks of chemotherapy. This article highlights the misconceptions regarding carboplatin and provides reasons for an argument why radiotherapy is better when a patient with Stage I seminoma chooses to undergo adjuvant treatment. [ABSTRACT FROM AUTHOR]

Background: The loss of reduction of some adhesion molecules is associated with the invasive phenotype of carcinomas. The aim of this paper was to study the expression of some proteins related to the Wnt/β catenin signalling pathway in seminomas by immunohistochemical techniques in order to assess the contribution of this pathway to the tumoral development.Materials and Methods: Immunohistochemistry for E-cadherin, β-catenin, vimentin, C-Myc, cyclin D1 (CD1) and placental alkaline phosphatase. (PALP) was carried out in 24 archival tissue blocks of seminomas. Two cellular lines were used as E-cadherin and β-catenin controls. (JKT-1 and TCam-2).Results: E-cadherin was positive in two seminomas and in one carcinoma in situ. (CIS), showing a membranous pattern. βcatenin was principally expressed in Sertoli cells, in some malignant gonocytes of CIS and in the membranes of seminomatous cells. No β-catenin immunostaining was detectable in the cytoplasm and the nuclei of neoplastic cells. Seminomas were weakly possitive for vimentin in 11/24 cases. None of the tumors displayed expression of C-Myc or CD1.Conclusions: The results does not indicate the activation of the Wnt pathway, due to the lack of vimentin expression in 13/24 seminomas, the low expression in the rest of the cases, the lack of β-catenin in nuclei and the absence of CD1 and C-Myc expression. Further work is needed to confirm these observations and to test other signaling pathways in seminomas. [ABSTRACT FROM AUTHOR]

Central nervous system germ cell tumors are rare and they occur in the first two decades of life.[1] Optic nerve germinomas can sometimes mimic optic nerve inflammation.[2] In this case report, we discuss an 11-year-old girl who presented with features of presumed bilateral optic neuritis and developed polyuria and polydipsia, subsequently she was diagnosed to have infiltrative etiology. Her clinical and radiological presentations were initially consistent with inflammatory optic neuropathy. Poor visual recovery to steroid therapy and progressive visual loss warranted the need for optic nerve biopsy which revealed germinoma. [ABSTRACT FROM AUTHOR]

Intracranial germinomas are rare and account for <0.5% of primary intracranial tumors. In contrast to the gonadal germinomas, these do not show granulomatous response within the tumor. In rare cases, the granulomatous component may obscure the tumor proper and lead to diagnostic difficulties/dilemmas. We report a case of suprasellar germinoma in a 17-year-old boy which showed granulomatous response. We discuss the differentials to be considered in such a scenario and discuss the utility of squash cytology and immunohistochemistry in these lesions. [ABSTRACT FROM AUTHOR]

Ovarian germ cell tumors (GCTs) are rare and affect mainly young girls and women. Two histological groups are distinguished: dysgerminomas and nondysgerminomatous tumors. These tumors have initial good responses to surgery and chemotherapy in 80% cases, but >75% of patients die due to complications of disease progression. There are very few case reports of mixed GCT with extradural spine metastases. We report a rare case of a 17‑year‑old girl who had undergone left salpingo‑oophorectomy with omental and peritoneal biopsy for ovarian GCT with extradural spinal metastasis. [ABSTRACT FROM AUTHOR]

Aim: This study aims to identify clinical features, treatment outcomes, and prognostic factors for relapse and survival in patients with testicular seminoma.Materials and Methods: Retrospective analysis of all patients with pure seminoma treated at our center during over a decade (January 2005-December 2014) was carried out. Patient demographics, tumor characteristics, and treatment details and pattern of recurrence were recorded in a structured format, and disease-free survival and overall survival were calculated.Results: Sixty-three patients' case records were included in the analysis. Ten patients developed disease in the undescended testis. All patients underwent orchiectomy as the initial treatment procedure. Majority of the patients were Stage I (57.14%) followed by Stage II (39.6%). Among the patients with Stage I, 55.5% received adjuvant chemotherapy while 22.2% received adjuvant radiation and the rest opted for surveillance. The compliance for active surveillance was very poor. Among patients with Stage II disease, majority (80%) were treated with adjuvant chemotherapy and the rest with radiation. At a median follow-up of 49 months, there were four recurrences of which three were salvaged successfully, and one patient remained alive with disease. There were no disease-related deaths.Conclusions: Testicular seminoma remains to be relatively low and majority of them presented with Stage I disease and single agent carboplatin appeared to be the preferred adjuvant treatment. Advanced disease patients were treated with etoposide and cisplatin/bleomycin, etoposide and cisplatin chemotherapy and the clinical outcome is comparable with the Western literature. [ABSTRACT FROM AUTHOR]

Context: Nonurological malignancies in children include a wide variety of tumors. These tumors include primary tumors of the liver, thyroid, lung, gastrointestinal tract (GIT), and adrenals; soft tissue sarcomas (STSs) like rhabdomyosarcoma (RMS) and non-RMS; and finally extragonadal germ cell tumors (GCT). Aims: This article aims at describing the current thinking in the management of these childhood solid tumors. This is critical in view of the recent advances in the elucidation of the molecular, genetic, and biologic behavior of these tumors and how these factors are getting integrated not only in the staging but also in developing a risk-based approach towards the management of these tumors. Materials and Methods: Reference was made to recently published literature from the leading pediatric cancer centers of the world to make a sense of things of the most current thinking in this rapidly expanding field. This will provide surgeons and physicians taking care of these children with a working knowledge in this somewhat challenging field. Conclusions: Treatment results vary from center to center depending on access to resources and following different management protocols. Results have improved for these tumors with the advent of newer chemotherapeutic agents, novel delivery methods of radiation therapy (RT), and improvement in surgical technique. Due to the limited number of patients presenting with these tumors, national and international collaboration of data is critical for all and beneficial to individual treatment centers. This has resulted in better results in the past and will definitely result in still better results in the future. [ABSTRACT FROM AUTHOR]

Paratesticular germ cell tumors are extremely rare. A 12‑month‑old boy with yolk sac tumor involving only the paratesticular tissue is reported. Pre‑operatively raised alpha fetoprotein levels fell to normal levels after high inguinal orchiectomy. This appears to be the youngest and only the 3rd case reported in the English literature. [ABSTRACT FROM AUTHOR]

The sarcomatous differentiation occurring in spermatocytic seminoma (SS) renders an aggressive behavior with metastatic potential to this relatively indolent neoplasm. Correct identification of this sarcomatous component is essential as further management differs. Herein, we report a case of young male with SS with rapid increase in size of the tumor. Histopathology revealed a rhabdomyosarcomatous component infiltrating the rete-testis and epididymis along with a well-circumscribed SS. [ABSTRACT FROM AUTHOR]

Dual malignancy is rare in adolescents. Dual malignancy with the second malignancy of thyroid is rare. No association has been reported between dysgerminoma of ovary and carcinoma thyroid in medical literature. Despite a thorough PubMed search (key words -- Papillary carcinoma of thyroid, metachronous, dysgerminoma ovary), we were unable to find a previous reported case of metachronous papillary carcinoma of thyroid (PT C) following dysgerminoma of the ovary. After surgery, the patient is being regularly followed up for recurrence/development of new primary. We report this unusual and rare case in a 17-year-old female patient. [ABSTRACT FROM AUTHOR]

Yolk sac tumor (YST) is a rare neoplasm that affects children and adolescents. Fine needle aspiration biopsy is an extremely useful procedure for the diagnosis of YST. Main objective is to describe the characteristic cytological features of fine needle aspirates of YST. We report a case of YST in a 4-year-old male child occurring at paravertebral region showing cytomorphological details. [ABSTRACT FROM AUTHOR]

Yolk sac tumor is the most common germ cell tumor in infants and children. Majority of them arise in the gonads. Yolk sac tumor of undescended testis has been rarely diagnosed. We present a case of yolk sac tumor in right undescended testis in a 2-year-old child primarily diagnosed by fine needle aspiration cytology. [ABSTRACT FROM AUTHOR]

Synchronous intracranial germ cell tumor in the pineal and suprasellar region is rare. They represent only 5-10% of all intracranial germinomas. They are also known by the entity "double midline atypical teratoma" and are common in the second decade of life. We report a case of an 11-year-old girl having dual midline intracranial lesions with obstructive hydrocephalus treated by ventriculo-peritoneal shunt. Diagnosis of germinoma was made on the basis of imaging and elevated beta-human chorionic gonadotropin in cerebrospinal fluid. Radiotherapy was instituted, which resulted in the total disappearance of both the lesions. Clinical expression, diagnosis and management strategies are discussed. [ABSTRACT FROM AUTHOR]

The skin is an unusual site of metastases from solid organ malignancies. We report the case of a patient with a malignant mixed non-seminomatous germ cell tumor of the testis, presenting with cutaneous metastasis, which was treated with salvage chemotherapy. [ABSTRACT FROM AUTHOR]

Germ cell tumors may lead to incomplete isosexual male precocity and are commonly located in the pineal gland. Germinomas of the basal ganglia are almost always unilateral and precocious puberty is a rare manifestation in them. We report a 9.5-year-old boy who presented with incomplete isosexual precocity due to bilateral basal ganglia germinoma. [ABSTRACT FROM AUTHOR]

Germ cell tumor (GCT) is relatively uncommon in intracranial locations. They constitute ~ 0.3-0.6% of intracranial neoplasms and encompass a wide pathologic range. The majority occurs in young adults and occupies the midline locations like pineal gland followed by suprasellar compartment. These tumors are rare in the cerebral hemisphere, basal ganglia, thalamus and ventricles. Neuroimaging studies cannot differentiate GCTs from other tumors, and therefore, the diagnosis usually requires histological confirmation. Germ cell tumors can be divided into major groups including germinomas and nongerminomatous GCTs (NGGCTs). Their proper identification as well as histopathological typing is important as treatment and prognosis vary greatly between different groups. Germinomas have a superior prognosis and are more radiosensitive as compared to non-germinomatous germ cell tumors. Standard management is still controversial. In this case series we are presenting three cases of intracranial germ cell tumors arising in two unusual locations, that is intraventricular and thalamic region. Apart from the clinical, radiological, histopathological and surgical details we also discuss the various aspects of intracranial germ cell tumors. [ABSTRACT FROM AUTHOR]

This study aims to report a rare case of precocious puberty (PP) due to a human chorionic gonadotropin (hCG)-producing germinoma located in the suprasellar region. A 10-year-old male patient presented with sexual precocity, headache, drowsiness, loss of appetite, and papilledema. Significant acceleration of bone age in relation to chronological age, high serum total testosterone levels, and hypopituitarism (unresponsiveness to stimulation test) were observed. Magnetic resonance imaging (MRI) of the brain showed a large suprasellar tumor and triventricular dilatation. High hCG levels were found in both blood and cerebrospinal fluid. Hormone replacement therapy and transcranial surgery associated with radiotherapy were performed, with complete regression of sexual characteristics and normal laboratory tests post-operatively. Clinical and laboratory findings, in addition to MRI scans, led to the diagnosis of an hCG-producing tumor and PP, which represents a rare report in the literature. [ABSTRACT FROM AUTHOR]

Germinoma occurring in the medulla oblongata is extremely rare. We report a case of primary intracranial germinoma arising in the medulla oblongata of a 24-year-old postpartum female who presented with progressive weakness of upper and lower limbs, seventh nerve palsy, and decreased palatal movements. Her MR imaging showed a heterointense mass lesion in the posterior portion of upper medulla, the histology of which was reported as germinoma. Germ cell tumors should be considered in the differential diagnosis of tumors occurring in the brain stem. [ABSTRACT FROM AUTHOR]

Extraneural metastases of intracranial germinoma are rarely reported. The authors describe the first case of metastatic lung germinoma of the thoracic spine. A 27-year-old man presented with right shoulder pain and right upper limb weakness. He had a history of repetitive radiation therapy - nine (whole-abdomen; 15Gy), 12 (whole brain; 30Gy, whole spine 42Gy) and 14 years ago (local; 32Gy) - for abdominal metastasis, temporal and fourth ventricle metastasis and spinal dissemination and metastatic pineal germinoma, respectively. Magnetic resonance imaging revealed a lung mass invading the thoracic spine that was diagnosed as a germinoma by tumor biopsy. He was treated by irradiation with 54Gy and two cycles of chemotherapy with cisplatin and etoposide. He did not have any sign of tumor eight years later. [ABSTRACT FROM AUTHOR]

A case of pineal germinaoma spreading along the basal subarachnoid space, clinically and macroscopically at autopsy, resembling tuberculous basal arachnoiditis is reported. Need to carry out CSF cytology of even hemorrhagic CSF is stressed, to diagnose the condition. [ABSTRACT FROM AUTHOR]

The article presents a case study of an inguinal lymphnode metastatic testicular seminoma in a 30-year-old male presented with a right inguinal mass. His medical history include orchidectomy for right testicular mass but has normal values of human chorionic gonadotropin, alphafetoprotein, and lactate dehydrogenase. The patient undergone right inguinal lymphnode dissection, with histopathology confirming to be a case of inguinal metastatic classic seminoma testis.

Dr. Abani Kanta Nanda Department of Radiotherapy, AH Regional Cancer Centre, Cuttack INTRODUCTION:- The incidence of CNS Germ cell tumour varies significantly according for 0.1 to 3.4% of all primary Brain tumors. Though rare, germinomas are the most common Germ Cell Tumor composing 36-70% of all cases.Presenting here a case of Germinoma of Pituitary due to its rarity. CASE DESCRIPTION:-A 17 year Hindu Female presented with menstrual disturbances since 2 years, progressive loss of vision in both eyes and severe headache since 1 year with no associated CNS abnormalities. Her CT scan and MRI of brain showed a bilobed lobulated mass in sellar and supra sellar region compressing the bilateral optic chiasma. Right pterional craniotomy and partial excision was done on 26/07/17. The biopsy revealed 'GERMINOMA'. On hormonal study, Serum growth hormone level is 0.03ng/ml (N->0.01-3.61 ng/ml);serum LH level is 0.1 mIU/ml(N-> 2.4-12.6mIU/ml in follicular phase);Serum FSH level is 0.143mIU/ml(N->3.5-12.5mIU/ml in follicular phase) and Serum Prolactin Level is 1.75ng/ml(N->3-26ng/ml). CSF beta hCG level is 62.27 mIU/ml(N->2.5-16mIU/ml) and CSF AFP is 0.605 ng/ ml(N- <1.5ng/ml). DISCUSSION :-Germinomas typically present in pineal gland (38% to 57%) or supra sellar region(34% to 49%) .CNS Germinomas have a Male to Female ratio 1.8-3.5:1 and diagnosed at a mean age of 11 to 12 year, usually before 20 year of age.The present case was a female of 17 yrs presented with Germinoma of Pituitary. Patient is having Hypopitutarism hence suffering from menstrual abnormalities. Germinomas do not secrete AFP but may secrete low levels of beta hCG. Hence, AFP and beta hCG in CSF are not a diagnostic tool and biopsy is essential in diagnosis in this case. CONCLUSION:- Germinomas of Sellar and Supra sellar region is very rare among primary CNS Tumors. It is even more rare among Females. Symptoms in this CNS Tumor are according to position of Tumor. CNS Germinomas can be confirmed by Biopsy. CSF AFP and beta hCG levels provide only supportive evidence. [ABSTRACT FROM AUTHOR]

Background: Primary germ cell tumors (GCT) of the central nervous system (CNS) are a rare and heterogeneous group of neoplasias with distinct histological subtypes. In adults, the most common sites are the anterior mediastinum, retroperitoneum, and the pineal and suprasellar regions. In infants and young children, intracranial GCTs and sacrococcygeal teratomas are more common than other locations. Intracranial GCTs arise almost exclusively from midline locations. The two most frequent sites are the pineal gland and the suprasellar regions, with pineal tumors occurring nearly twice as often as suprasellar GCTs. Suprasellar tumors -- Suprasellar GCTs most commonly present with hypothalamic/pituitary dysfunctions, including diabetes insipidus, delayed pubertal development or precocious puberty, isolated growth hormone deficiency, or other aspects of hypopituitarism (central hypothyroidism, adrenal insufficiency). Objectives: To report an unusual presentation of intracranial GCT. Design/Method: Case report Case report: A 11-yearold girl presented with unilateral progressive loss of vision for one month. MRI brain revealed a well-defined lesion in the floor of the 3rd ventricle/hypothalamus region. Optic chiasma and Right distal optic nerve showed oedematous changes. Differential diagnosis like Germinoma or Glioma were considered. She had no other focal neurologic deficits or signs of endocrinopathy. Biopsy from lesion was suggestive of Grade I Germinoma, IHC was positive for PLAP. She received 2 cycles of NACT with Cisplatin & Etoposide followed by IMRT (2520cGy/14Fr/5Fr/wk ? 1980cGy/11Fr Boost) to ventricles. She had also received one cycle adjuvant chemotherapy with Cisplatin & Etoposide. Response assessment MRI showed complete resolution of lesion with residual oedema. Post treatment patient had improved vision and is on regular follow-up. Discussion: Patients with suprasellar GCTs often have chronic subtle symptoms, and their tumors are diagnosed incidentally on imaging studies performed for unrelated reasons. Suprasellar GCTs can also cause ophthalmologic abnormalities such as decreased visual acuity from chiasmic or optic nerve compression or visual field deficit (classically, bitemporal hemianopsia). It is unusual for suprasellar tumors to have acute onset, rapid progression, unilateral symptoms and absence of endocrinopathy. Conclusion: Our case is unique for the acute onset, unilateral visual disturbances, absence of endocrinopathy. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented aimed at presenting a case of pure seminoma testes admitted with urinary tract obstruction leading to urinary stasis and urosepsis leading to acute renal failure.

Therapy related AML (t- AML) accounts for 10-20% of all cases of AML. Cytotoxic agents implicated are alkylating agents, topoisomerase II inhibitors and rarely anti metabolites and anti tubulin agents. A growing incidence of therapy related acute promyelocytic leukemia (t-APL) has been reported over the last few decades in malignant and non malignant conditions. To the best of our knowledge this is the first t-APL case report to be reported in NSGCT post etoposide based therapy. [ABSTRACT FROM AUTHOR]

Germ cell tumors of ovary with elements of two or more subtypes are relatively uncommon. Sarcoid-like granulomas are seen in rare association with dysgerminomas, a subgroup of germ cell tumors of ovary, which are again less common. Fine-needle aspiration cytology (FNAC) of the gonadal germ cell tumor, though not performed frequently, is of help when a gonadal mass does not require resection as in lymphoma which can be treated by chemotherapy. FNAC helps to diagnose this tumor and to rule out other lesions, including germ cell tumors. It is also an effective, rapid and reliable procedure for the diagnosis of germ cell tumors. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 27-year-old man with painless scrotal swelling having solitary testis from birth. Topics discussed include fine needle aspiration cytology (FNAC) of testicular mass revealed seminoma of testis; blood test detected raised placental alkaline phosphatase level; and high inguinal orchiectomy performed under spinal anesthesia.