title: Intracranial germ cell tumors: a multi-institutional experience from three tertiary care centers in India.
abstract: OBJECTIVE
  Central nervous system germ cell tumors (CNS GCTs) are relatively rare neoplasms. Incidence of CNS GCTs in Western literature is low (0.3-0.6 %) as compared to East Asia (3-4 %). No large study is available on CNS GCTs from India.
  
  
  METHODS
  Intracranial GCT cases were retrieved from databases of three tertiary care institutes in India; clinicopathological data was reviewed.
  
  
  RESULTS
  Ninety-five intracranial GCT cases were identified, accounting for 0.43 % of CNS tumors. Median age was 12 years (range, birth to 48 years); male preponderance was noted (66 %). Most patients (86.3 %) were aged <18 years. Pineal location was most common (45 %) and was associated with male gender and age >14 years. Germinoma was the commonest histopathological type (63.2 %), followed by teratoma (20 %). Suprasellar location was associated with germinoma histology. Follow-up was available for 71 patients (median, 15 months). Of these, 48 received adjuvant chemotherapy and/or radiotherapy. At the last follow-up, 44 patients showed no evidence of disease. Age >10 years, male gender, pineal location, and germinoma histology were associated with favorable outcome.
  
  
  CONCLUSIONS
  This is the first multicentric study from India establishing that incidence of CNS GCT in India is similar to that in the West and differs from that in East Asian countries. However, similar to both, germinoma is the commonest histological type, and pineal location is most frequent. Studies on molecular alterations based on ethnicity and geographical location are necessary to provide clarity on differences in incidence. Attention needs to be focused on decreasing treatment heterogeneity and minimizing treatment-related morbidity and mortality, improving the cure rate of these highly treatable tumors.
authors.affiliation: Department of Pathology, All India Institute of Medical Sciences, New Delhi, 110029, India.
authors.forename: Aanchal
authors.initials: A
authors.lastname: Kakkar
authors.affiliation: Department Radiation Oncology, All India Institute of Medical Sciences, New Delhi, 110029, India.
authors.forename: Ahitgani
authors.initials: A
authors.lastname: Biswas
authors.affiliation: Neuro Oncology Group, Tata Memorial Hospital, Mumbai, 400012, India.
authors.forename: Nikhil
authors.initials: N
authors.lastname: Kalyani
authors.affiliation: Department of Pathology, IPGMER, Kolkata, 700020, India.
authors.forename: Uttara
authors.initials: U
authors.lastname: Chatterjee
authors.affiliation: Department of Pathology, All India Institute of Medical Sciences, New Delhi, 110029, India.
authors.forename: Vaishali
authors.initials: V
authors.lastname: Suri
authors.affiliation: Department of Pathology, All India Institute of Medical Sciences, New Delhi, 110029, India.
authors.forename: Mehar C
authors.initials: MC
authors.lastname: Sharma
authors.affiliation: Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, 110029, India.
authors.forename: Nishant
authors.initials: N
authors.lastname: Goyal
authors.affiliation: Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, 110029, India.
authors.forename: Bhawani S
authors.initials: BS
authors.lastname: Sharma
authors.affiliation: Department Radiation Oncology, All India Institute of Medical Sciences, New Delhi, 110029, India.
authors.forename: Supriya
authors.initials: S
authors.lastname: Mallick
authors.affiliation: Department Radiation Oncology, All India Institute of Medical Sciences, New Delhi, 110029, India.
authors.forename: Pramod K
authors.initials: PK
authors.lastname: Julka
authors.affiliation: Neuro Oncology Group, Tata Memorial Hospital, Mumbai, 400012, India.
authors.forename: Girish
authors.initials: G
authors.lastname: Chinnaswamy
authors.affiliation: Neuro Oncology Group, Tata Memorial Hospital, Mumbai, 400012, India.
authors.forename: Brijesh
authors.initials: B
authors.lastname: Arora
authors.affiliation: Neuro Oncology Group, Tata Memorial Hospital, Mumbai, 400012, India.
authors.forename: Epari
authors.initials: E
authors.lastname: Sridhar
authors.affiliation: Department of Neurosurgery, Park Clinic, Kolkata, India.
authors.forename: Sandip
authors.initials: S
authors.lastname: Chatterjee
authors.affiliation: Neuro Oncology Group, Tata Memorial Hospital, Mumbai, 400012, India.
authors.forename: Rakesh
authors.initials: R
authors.lastname: Jalali
authors.affiliation: Department of Pathology, All India Institute of Medical Sciences, New Delhi, 110029, India. sarkar.chitra@gmail.com.
authors.forename: Chitra
authors.initials: C
authors.lastname: Sarkar
mesh_terms: D000293:Adolescent; D000328:Adult; D001932:Brain Neoplasms / Q000453:epidemiology* / Q000473:pathology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D015994:Incidence; D007194:India / Q000453:epidemiology; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D009373:Neoplasms, Germ Cell and Embryonal / Q000453:epidemiology* / Q000473:pathology*; D062606:Tertiary Care Centers; D055815:Young Adult
keywords: Central nervous system; Germ cell tumor; Germinoma; Intracranial; Pineal; Suprasellar