Introduction:
Germ Cell Tumors are the neoplasm arising from primordial germ cells which produces specialized cells in the body like sperm and egg cells. With the recent advances in cisplatin based chemotherapy, the cure rate of germ cell tumors is increased if diagnosed in early stages. It frequently occurs in three modal peaks of life, infancy, 25-40 yrs and around 60 yrs.
Germ Cell Tumors are the neoplasm arising from primordial germ cells which produces specialized cells in the body like sperm and egg cells. With the recent advances in cisplatin based chemotherapy, the cure rate of germ cell tumors is increased if diagnosed in early stages. It frequently occurs in three modal peaks of life, infancy, 25-40 yrs and around 60 yrs.
Sites:
Testes
Ovaries
Paratesticular area
Abdomen (retroperitoneum)
Mediastinum
Brain
Types:
Malignant GCTs: The tumors such as yolk sac tumors, choriocarcinoma, and immature tearatomas encompass this type. The elevated tumor markers, rapid growth signifies malignant transformation.
Benign GCTs: Teratomas are benign tumors. They have characteristic appearance where there are teeth, bone, hair is found inside the tumor.
Symptoms:
Painless scrotal mass
Abdominal mass
Abdominal pain
Breathlessness
Sacral mass
Mediastinal mass
Investigations:
Tumor markers like AFP, β-HCG, LDH
Biopsy
CT Scan/ MRI
Treatment:
Surgery: The location of the tumor may influence the need for surgery. When possible, the first choice is usually to try and remove the entire tumor. This can be enough to cure most teratomas and immature teratomas. The coccyx needs to be removed in case of sacrococcygeal teratomas.
Chemotherapy: BEP (Bleomycin, Etoposide & Cisplatin) is the first line chemotherapy for the malignant germ cell tumors. This tumors are very much chemosensitive & the fall in tumor marker gives the idea about the response. If the complete resection is not possible initially then neoadjuvant chemotherapy is advisable.
Radiotherapy: It is indicated as a local therapy when the surgery is not possible.
Prognosis:
The 5-year survival rate is about 95% in germ cell tumors.
Testes
Ovaries
Paratesticular area
Abdomen (retroperitoneum)
Mediastinum
Brain
Types:
Malignant GCTs: The tumors such as yolk sac tumors, choriocarcinoma, and immature tearatomas encompass this type. The elevated tumor markers, rapid growth signifies malignant transformation.
Benign GCTs: Teratomas are benign tumors. They have characteristic appearance where there are teeth, bone, hair is found inside the tumor.
Symptoms:
Painless scrotal mass
Abdominal mass
Abdominal pain
Breathlessness
Sacral mass
Mediastinal mass
Investigations:
Tumor markers like AFP, β-HCG, LDH
Biopsy
CT Scan/ MRI
Treatment:
Surgery: The location of the tumor may influence the need for surgery. When possible, the first choice is usually to try and remove the entire tumor. This can be enough to cure most teratomas and immature teratomas. The coccyx needs to be removed in case of sacrococcygeal teratomas.
Chemotherapy: BEP (Bleomycin, Etoposide & Cisplatin) is the first line chemotherapy for the malignant germ cell tumors. This tumors are very much chemosensitive & the fall in tumor marker gives the idea about the response. If the complete resection is not possible initially then neoadjuvant chemotherapy is advisable.
Radiotherapy: It is indicated as a local therapy when the surgery is not possible.
Prognosis:
The 5-year survival rate is about 95% in germ cell tumors.
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