Spinal intradural primary germ cell tumour--review of literature and case report.
BACKGROUND
Primary spinal cord germ cell tumour is a rare tumour. We herein review the tumour characteristics, associated risk factors, treatment policy, and patterns of failure of primary intradural germ cell tumour.


METHODS
We conducted a PUBMED search using a combination of keywords such as "spinal germ cell tumor," "germinoma," "extradural," "intradural," "intramedullary," "extramedullary," and identified 19 cases of primary spinal germ cell tumour. Clinical features, pathologic characteristics, and treatment details of these patients including status at follow-up were noted from respective case reports. We also describe a case of a young Indian patient of intradural extramedullary germ cell tumour treated with a combination of surgery, chemotherapy, and radiotherapy.


RESULTS
The median age at presentation was 24 years. The most common location of the tumour was thoracic (40%). Beta-HCG overproduction was noted in 40% of the patients. Most patients were treated with a combination of surgery, radiation therapy, and systemic chemotherapy. Median follow-up was 16.5 months. Recurrence was observed in 10% of the patients, all in beta-HCG over-producing tumours. The illustrative case was a 28-year male, presenting with pain in lower back and both lower limbs for 2 months. Magnetic resonance imaging spine showed an inhomogeneous hyperintense soft tissue mass at L(2)-L(4) spinal level. He was treated with complete surgical excision and four cycles of chemotherapy with BEP regimen following a histological diagnosis of non-seminomatous germ cell tumour. Palliative irradiation to the lumbar spine was given on progression at 3 months. The patient eventually succumbed to his condition, due to compressive transverse myelitis possibly due to cervical cord metastasis.


CONCLUSIONS
Limited surgery followed by upfront radiation therapy and adjuvant chemotherapy is the optimal management of this rare group of tumour. Omission of radiation therapy from the treatment armamentarium might engender local recurrence and spinal dissemination at first failure.
Biswas
Ahitagni
A
Department of Radiotherapy, All India Institute of Medical Sciences, New Delhi, India. dr_ahitagni@yahoo.co.in
Puri
Tarun
T
Goyal
Shikha
S
Gupta
Ruchika
R
Eesa
Muneer
M
Julka
Pramod Kumar
PK
Rath
Goura Kishor
GK
D000328:Adult; D000970:Antineoplastic Agents / Q000627:therapeutic use; D014408:Biomarkers, Tumor / Q000032:analysis / Q000378:metabolism; D018997:Chorionic Gonadotropin, beta Subunit, Human / Q000032:analysis / Q000378:metabolism; D019299:Decompression, Surgical; D018450:Disease Progression; D017809:Fatal Outcome; D006801:Humans; D008159:Lumbar Vertebrae; D008279:Magnetic Resonance Imaging; D008297:Male; D009188:Myelitis, Transverse / Q000209:etiology; D009362:Neoplasm Metastasis / Q000473:pathology; D009364:Neoplasm Recurrence, Local / Q000532:radiotherapy; D009373:Neoplasms, Germ Cell and Embryonal / Q000473:pathology* / Q000628:therapy*; D019635:Neurosurgical Procedures; D011878:Radiotherapy; D013116:Spinal Cord / Q000473:pathology*; D013120:Spinal Cord Neoplasms / Q000473:pathology* / Q000628:therapy*; D013346:Subarachnoid Space / Q000473:pathology / Q000601:surgery
D000970:Antineoplastic Agents; D014408:Biomarkers, Tumor; D018997:Chorionic Gonadotropin, beta Subunit, Human