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Extragonadal and central nervous system germ cell tumors: A review of diagnostic and therapeutic strategies

  • Eliot L. Friedman
  • Marc B. Garnick
Chapter
Part of the Cancer Treatment and Research book series (CTAR, volume 36)

Abstract

Neoplasms arising in germ cells are relatively uncommon, but are highly curable malignancies. The incidence of primary testicular tumors ranges from approximately 2.1 to 3.1 cases per 100,000 males in the United States and Great Britain [1]. Amongst those cases of germ cell tumors about 1% to 2% have an extragonadal origin. These tumors possess a similar spectrum of pathologies as their primary testicular counterparts [2–6] and include all types of seminomas and nonseminomas. A scheme of the interrelationship of these neoplasms was developed by Teilum [7] and is depicted in figure 1. Several controversies surround the subject of extragonadal germ cell tumors (EGGCT) including their pathogenesis and etiology, the question of ‘burned out’ testicular primaries, the necessity for orchiectomy, and the observation that these tumors may be more refractory to the standard chemotherapeutic regimens used in primary testicular cancer. This review will attempt to provide a review of EGGCT’s including their origin, clinical syndromes, past therapeutic strategies, and further directions of treatment.

Keywords

Germ Cell Germ Cell Tumor Embryonal Carcinoma Primordial Germ Cell Pineal Tumor 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Collins DH and Pugh RB: Classification and frequency of testis tumors. Br J Urol (supplement) 36:1–11, 1964.PubMedGoogle Scholar
  2. 2.
    Cox JD: Primary malignant germ cell tumors of the mediastinum: A study of 24 cases. Cancer 36:1162–1168, 1975.PubMedGoogle Scholar
  3. 3.
    Huntington RW and Bullock WK: Yolk sac tumors of extragonadal origin. Cancer 25:1368–1376, 1970.PubMedGoogle Scholar
  4. 4.
    Lynch MJG and Blewett GL: Choriocarcinoma arising in the male mediastinum. Thorax 8:157–161, 1953.PubMedGoogle Scholar
  5. 5.
    Peison B: Embryonal teratocarcinoma of the mediastinum in a woman with foci of anaplastic cells stimulating chorioepithelioma. Chest 58:169–172, 1970.PubMedGoogle Scholar
  6. 6.
    Woolner JB, Jamplis RW, and Kirklin JW: Seminoma apparently primary in the anterior mediastinum. N Engl J Med 252:653–657, 1955.PubMedGoogle Scholar
  7. 7.
    Teilum G: Classification of endodermal sinus tumors and so-called embryonal carcinoma of the ovary. Acta Path Microbiol Scand 64:407–427, 1965.PubMedGoogle Scholar
  8. 8.
    Witschi E: Migration of the germ cells of human embryos from the yolk sac to the primitive gonadal folds. Contrib Embryology 32:69–80, 1948.Google Scholar
  9. 9.
    Schlumberger HG: Teratoma of the anterior mediastinum in the group of military age. Archives of Pathology 41:398–444, 1953.Google Scholar
  10. 10.
    Pugsley WS and Carleton RL: Germinal nature of teratoid tumors of the thymus. Arch Path 56:341–347, 1953.Google Scholar
  11. 11.
    Friedman NB: The comparative morphogenesis of extragenital and gonadal teratoid tumors. Cancer 4:265–276, 1951.PubMedGoogle Scholar
  12. 12.
    Dixon and Moore: Tumors of male sex organs. Atlas of Human Pathology, Section 8, Fascicle #1. Washington, DC: Armed Forces Institute of Pathology, plates 316, R32.Google Scholar
  13. 13.
    Prym P: Spontanheilung ernes bosartigen wahrscheinlich chorionepitheliomatosen gewasches in Hoden. Virchows Arch fur Pathol 265:239–258, 1927.Google Scholar
  14. 14.
    Stowell RE, Sachs E, and Russel WO: Primary intracranial chorioepithelioma with metastases to the lung. Am J Path 21:787–800, 1945.PubMedGoogle Scholar
  15. 15.
    Rather LJ, Gardiner WR, and Frerichs JB: Regression and maturation of primary testicular tumors with progressive growth of metastases. Stanford Medical Bulletin 12:12–25, 1954.PubMedGoogle Scholar
  16. 16.
    Greenwood SM, Goodman JR, Schneider G, Forma BH, Kress SC, and Gelf AF: Choriocarcinoma in a man. Am J Med 51:416–422, 1971.PubMedGoogle Scholar
  17. 17.
    Azzopardi JG and Hoffbrand AV: Retrogression in testicular seminoma with viable metastases. J Clin Path 18:135–141, 1965.PubMedGoogle Scholar
  18. 18.
    Azzopardi JG, Mostofi FK, and Theiss EA: Lesions of the testes observed in certain patients with widespread choriocarcinoma and related tumors. Am J Path 38:207–225, 1961.PubMedGoogle Scholar
  19. 19.
    Abell MR, Fayos JV, and Lampe I: Retroperitoneal germinomas without evidence of testicular involvement. Cancer 18:273–290, 1965.PubMedGoogle Scholar
  20. 20.
    Luna MA and Valenzuela-Tamariz J: Germ cell of the mediastinum, postmortem findings. Am J Clin Path 65:450–454, 1976.PubMedGoogle Scholar
  21. 21.
    Houghton JD: Malignant teratoma of the mediastinum: Report of a case and review of 24 cases from the literature. Am J Path 12:349–371, 1936.PubMedGoogle Scholar
  22. 22.
    Asif S and Vehling DT: Microscopic tumor foci in testes. J Urol 99:776–779, 1968.PubMedGoogle Scholar
  23. 23.
    Brendler CB, Dees JE, Older RA, Fetter BF, and Glenn JF: Retroperitoneal mass in a 58-year-old man. J Urol 122:535–538, 1979.PubMedGoogle Scholar
  24. 24.
    Burt ME and Javadpour N: Germ cell tumors in patients with apparently normal testes. Cancer 47:1911–1915, 1981.PubMedGoogle Scholar
  25. 25.
    Friedman and Moore: Military Surgery 99:573, 1946.Google Scholar
  26. 26.
    Johnson DE, Laneri JP, Mountain CF, and Luna M: Extragonadal germ cell tumors. Surgery 73:85–90, 1973.PubMedGoogle Scholar
  27. 27.
    Meares EM and Briggs EM: Occult seminoma of the testis masquerading as primary extragonadal germinal neoplasms. Cancer 30:300–306, 1972.PubMedGoogle Scholar
  28. 28.
    Montague DK: Retroperitoneal germ cell tumors with no apparent testicular involvement. J Urol 113:505–508, 1975.PubMedGoogle Scholar
  29. 29.
    Wegenke JD, Chuprevich TW, and Nissom TEG: Retroperitoneal seminoma. J Urol 117:262–263, 1977.PubMedGoogle Scholar
  30. 30.
    Sample WF, Gottesman JE, Skinner DG, and Ehrlich RM: Gray scale ultrasound of the scrotum. Radiology 127:225–228, 1978.PubMedGoogle Scholar
  31. 31.
    Kirschling RJ, Kujols LK, Charboneau JW, Gratham JG, and Zincke H: High resolution ultrasonographic and pathologic abnormalities of germ cell tumors in patients with clinically normal testes. Mayo Clinic Proc 58:648–653, 1983.Google Scholar
  32. 32.
    Gold RH, Ehrlich RM, Samuels B, Dowdy A, and Young RT: Scrotal thermography. Radiology 122:129–132, 1977.PubMedGoogle Scholar
  33. 33.
    Allyn DL, Silverberg SC, and Salzberg AM: Endodermal sinus tumor of the vagina: Report of a case with 7-year survivals and literature review of so-called ’mesonephromas.’ Cancer 27:1231–1238, 1971.PubMedGoogle Scholar
  34. 34.
    Norris HJ, Bagley GP, and Taylor HB: Carcinoma of the infant vagina. Arch Path 90:473–479, 1970.PubMedGoogle Scholar
  35. 35.
    Hart WR: Primary endodermal sinus tumor of the liver. First reported case. Cancer 35:1453–1458, 1975.PubMedGoogle Scholar
  36. 36.
    Holt LP, Melcher DH, and Colquhoun J: Extragonadal choricoarcinoma in the male. Postgrad Med J 41:134–138, 1965.PubMedGoogle Scholar
  37. 37.
    Wurzel J and Brooks JJ: Primary gastric choriocarcinoma: Immunohistochemistry, postmortem documentation, and hormonal effects in a postmenopausal female. Cancer 48:2756–2761, 1981.PubMedGoogle Scholar
  38. 38.
    Conklin J and Abell MR: Germ cell neoplasms of sacrococcygeal region. Cancer 20:2105–2117, 1967.PubMedGoogle Scholar
  39. 39.
    Kenefick JS: Hereditary sacral agenesis associated with presacral tumors. Br J Surg 60:271–274, 1983.Google Scholar
  40. 40.
    Weedon D and Musgrave J: Endodermal sinus tumor of the face. Pathology 6:365–369, 1974.PubMedGoogle Scholar
  41. 41.
    Araki C and Matsumoto S: Statistical reevaluation of pinealoma and related tumors in Japan. J Neurosurg 30:146–149, 1969.PubMedGoogle Scholar
  42. 42.
    Kuzur ME, Cobleigh MA, Greco A, Einhorn LH, and Oldham RK: Endodermal sinus tumors of the mediastinum. Cancer 50:766–774, 1982.PubMedGoogle Scholar
  43. 43.
    Roth LW and Panganiban WG: Gonadal and extragonadal yolk sac carcinomas: A clinicipathologic study of 14 cases. Cancer 37:812–820, 1976.PubMedGoogle Scholar
  44. 44.
    Talerman A, Haije WG, and Baggerman L: Alpha-1 antirypsin and alphafetoprotein in sera of patients with germ cell neoplasms: Value as tumor markers in patients with endodermal sinus (yolk sac) tumors. Int J Cancer 19:741–746.Google Scholar
  45. 45.
    Bagshawe KD and Harland S: Immunodiagnosis and monitoring of gonadotrophin-producing metastases in the central nervous system. Cancer 38:112–118, 1976.PubMedGoogle Scholar
  46. 46.
    Forest JC, Talbot J, Page M, and Loiselle JM: Tumour antigens assoicated with primary mediastinal choriocarcinomas. CMA Journal 117:1386–1388, 1977.Google Scholar
  47. 47.
    Kadish SP, Bruckman JE, Perry ME, and Hardman JM: Retroperitoneal germinoma marked by elevated serum lactic dehydrogenase. Cancer 37:931–934, 1976.PubMedGoogle Scholar
  48. 48.
    Lee M, Ray PS, and Sharifi R: Elevated serum calcitonin associated with an extragonadal seminoma. J Urol 128:392–394, 1982.PubMedGoogle Scholar
  49. 49.
    Fox RM, Wood RL, and Tattersall MHN: Undifferentiated carcinoma in young men: The atypical teratoma syndrome. Lancet 1:1316–1318, 1979.PubMedGoogle Scholar
  50. 50.
    Richardson RL, Schomacher RA, Fer MF, Hande KR, Forbes JJ, Oldham RK, and Greco FA: The unrecognized extragonadal germ cell cancer syndrome. Ann Intern Med 94:181–186, 1981.PubMedGoogle Scholar
  51. 51.
    Allen JC, Nisselbaum J, Epstein F, Rosen G, and Schwartz MK: Alphafetoprotein and human chorionic gonadotrophin determination in cerebrospinal fluid. J Neurosurg 51:368–374, 1979.PubMedGoogle Scholar
  52. 52.
    Haase J and Norgaard-Pedersen B: Alphafetoprotein and human chorionic gonadotrophin as biochemical markers of intracranial germ cell tumors. Acta Neurochirurgica 50:67–69, 1979.PubMedGoogle Scholar
  53. 53.
    Silverman NA and Sabiston DC: Primary tumors and cysts of the mediastinum. Curr Prob Surg 2:1–54, 1977.Google Scholar
  54. 54.
    Polansky SM, Barwick KW, and Ravin CE: Primary mediastinal seminoma. Am J Radiol 132:17–21, 1979.Google Scholar
  55. 55.
    Recondo J and Libshitz HI: Mediastinal extragonadal germ cell tumors. Urology 11:369–375, 1978.PubMedGoogle Scholar
  56. 56.
    Vogelzang NJ, Raghavan D, Anderson RW, Rosai J, Levitt SH, and Kennedy BJ: Mediastinal nonseminomatous germ cell tumors: The role of combined modality therapy. Ann Thor Surg 3:333–339, 1982.Google Scholar
  57. 57.
    Hurt RD, Bruckman JE, Farron GM, Bernatz PE, Hahn RG, and Earle JD: Primary anterior mediastinal seminoma. Cancer 49:1658–1663, 1982.PubMedGoogle Scholar
  58. 58.
    Martini N, Golbey RB, Hajdu SI, Whitmore WF, and Beattie EJ: Primary mediastinal germ cell tumors. Cancer 33:763–769, 1974.PubMedGoogle Scholar
  59. 59.
    Bergh NP, Gatzinsky P, Larsson S, Lundin P, and Ridell B: Tumors of the thymus and thymic region: III. Clinicopathologic studies on teratomas and tumors of germ cell type. Ann of Thoracic Surg 25:107–111, 1977.Google Scholar
  60. 60.
    Fine G, Smith RW, and Patenter MR: Primary extragenital choriocarcinoma in the male subject. Am J Med 32:776–794, 1962.PubMedGoogle Scholar
  61. 61.
    Jernstom P and McLaughlin H: Choriocarcinoma of the thymus. JAMA 182:147–151, 1962.Google Scholar
  62. 62.
    Sickles EA, Belliveau RE, and Wiernik PH: Primary mediastinal choriocarcinoma in the male. Cancer 33:1196–1203, 1974.PubMedGoogle Scholar
  63. 63.
    Buskirk SJ, Evans RG, Farrow GM, and Earle JD: Primary retroperitoneal seminoma. Cancer 49:1934–1936.Google Scholar
  64. 64.
    Cortes-Funes H, Mendez M, Alonso E, Ouiben R, Manas A, Mendiola C: Mediastinal germ cell tumors treated with cisplatin, bleomycin, and vinblastine. Proceedings of the American Society of Clinical Oncology, 1981 Annual Meeting 1981:474 (C-553).Google Scholar
  65. 65.
    Dittler HJ, Mack D, and Stever G: Endodermal sinus tumor, seminoma, and hemangiopericytoma. Rare primary mediastinal tumors. A report on the course of the disease in nine patients. Thoracic Cardiovascular Surgery 28:259–264, 1980.Google Scholar
  66. 66.
    Feun LG, Samson MK, and Stephens RL: Vinblastine, bleomycin cis-diammine-dichloroplatinum in disseminated extragonadal germ cell tumors. A Southwest Oncology Group Study. Cancer 45:2543–2549, 1980.PubMedGoogle Scholar
  67. 67.
    Garnick MB, Canellos GP, and Richie JP: Treatment and surgical staging of testicular and primary extragonadal germ cell cancers. JAMA 250:1733–1741, 1983.PubMedGoogle Scholar
  68. 68.
    Hainsworth JD, Einhorn LH, Williams SD, Stewart M, and Greco FA: Advanced extragonadal germ cell tumors. Successful treatment with combination chemotherapy. Ann Intern Med 97:7–11, 1982.Google Scholar
  69. 69.
    Jain KK, Bosl GJ, Bains MS, Whitmore WF, and Golbey RB: The treatment of extragonadal seminoma. J Clin One 2:820–827, 1984.Google Scholar
  70. 70.
    Medini E, Levitt SH, Jones TK, and Rao Y: The management of extratesticular seminoma without gonadal involvement. Cancer 44:2032–2038, 1979.PubMedGoogle Scholar
  71. 71.
    Raghavan D and Barnett A: Mediastinal seminomas. Cancer 46:1187–1191, 1980.PubMedGoogle Scholar
  72. 72.
    Schantz A, Sewall W, and Castelona B: Mediastinal germinoma: A study of 21 cases with an excellent prognosis. Cancer 30:1189–1194, 1972.PubMedGoogle Scholar
  73. 73.
    Utz DC and Buscemia MF: Extragonadal germ cell tumors. J Urol 105:271–274, 1971.PubMedGoogle Scholar
  74. 74.
    Walden PAM, Woods RL, Fox B, and Bagshawe KD: Primary mediastinal trophoblastic teratomas. Thorax 32:752–758, 1977.PubMedGoogle Scholar
  75. 75.
    Luna MA and Johnson: Postmortem findings in testicular tumors. In: Testicular Tumors, Johnson DE (ed). New York: New York Medical Examination Publishing Company, 1975, pGoogle Scholar
  76. 76.
    Underlieder RS, Donaldson SS, Warnke RA, and Wilbur JR: Endodermal sinus tumors: The Stanford experience and the first reported case arising in the vulva. Cancer 41:1627–1634, 1978.Google Scholar
  77. 77.
    Sterchi M and Cordell AR: Seminoma of the anterior mediastinum. Annals of Thoracic Surgery 19:371–377, 1975.PubMedGoogle Scholar
  78. 78.
    Lee YM and Jackson SM: Primary seminoma of the mediastinum. Cancer control agency of British Columbia experience. Cancer 55:450–452, 1985.PubMedGoogle Scholar
  79. 79.
    Einhorn LH and Williams SD: Chemotherapy of disseminated testicular cancer. Cancer 1339–1344, 1980.Google Scholar
  80. 80.
    Garnick MB and Griffin JD: Idiopathic thrombocytopenia in association with extragonadal germ cell tumors. Ann Intern Med 98:926–927, 1983.PubMedGoogle Scholar
  81. 81.
    Nichols CR, Hoffman R, Einhorn LH, Williams SD, Wheeler LA, and Garnick MB: Hematologic malignancies associated with primary mediastinal germ cell tumors. Ann Intern Med 102:603–609, 1985.PubMedGoogle Scholar
  82. 82.
    Harnden DG, Malean N, and Langlands AO: Cancer of the breast and Klinefelter’s syndrome. J Med Genetics 8:460–461, 1971.Google Scholar
  83. 83.
    Storm PB, Fallon B, and Bunge RG: Mediastinal choriocarcinoma in a chromatin positive boy. J Urol 116:838–840, 1976.PubMedGoogle Scholar
  84. 84.
    Sogge MR, McDonald SD, and Cofold PB: The malignant potential of the dysgenetic germ cell in Klinefelter’s syndrome. Am J Med 66:515–518, 1979.PubMedGoogle Scholar
  85. 85.
    Mukerjee D, Bowen J, and Anderson DE: Simian papovavirus 40 transformation of cells from cancer patients with XY-XXY mosaic Klinefelter’s syndrome. Cancer Res 30:1769–1771, 1970.PubMedGoogle Scholar
  86. 86.
    Theiss EA, Ashley DJB, and Mostofi FK: Nuclear sex of testicular tumors and some related ovarian and extragonadal neoplasms. Cancer 13:323–327, 1960.PubMedGoogle Scholar
  87. 87.
    Schimke RN, Madigan CM, Silver BJ, Fabian CJ, and Stephens RL: Choriocarcinoma, thyrotoxicosis, and the Klinefelter syndrome. Cancer Genetics and Cytogenetics 9:1–8, 1983.PubMedGoogle Scholar
  88. 88.
    Kaplan CG, Askin FB, Benirschke K: Cytogenetics of extragonadal tumors. Teratology 19:261–266, 1979.PubMedGoogle Scholar
  89. 89.
    Bagshaw MA, McLaughlin WT, and Earle JD: Definitive radiotherapy of primary mediastinal seminomas. Am J Roentgen 105:86–94, 1969.PubMedGoogle Scholar
  90. 90.
    van Hoessel QCGM and Pinedo HM: Complete remission of mediastinal germ cell tumors with cis-dichlorodiammineplatinum (11) combination chemotherapy. Cancer Treat Rep 64:319–321, 1980.Google Scholar
  91. 91.
    Stanton GF, Bosl GF, Whitmore WF, Herr H, Sogani P, Morse M, and Golbey RB: VAB-6 as initial treatment of patients with advanced seminoma. J Clin Oncol 3:336–339, 1985.PubMedGoogle Scholar
  92. 92.
    Logothetis CJ, Samuels MJ, Selig DE, Dexeus FH, Johnson DE, Swanson DA, and von Eschenbach AC: Chemotherapy of extragonadal germ cell tumors. J Clin Oncol 3:316–325, 1985.PubMedGoogle Scholar
  93. 93.
    Garnick MB: Advanced testicular cancer: Treatment choices in the ’land of plenty.’ (editorial) J Clin Oncol 3:294–297, 1985.PubMedGoogle Scholar
  94. 94.
    Wolff SN, Fer MF, McKay CM, Hande KR, Hainsworth JD, and Greco FA: High dose VP-16–213, and autologous bone marrow transplantion for refractory malignancies: A phase I study. J Clin Oncol 1:701–705, 1983.PubMedGoogle Scholar
  95. 95.
    Greist A, Einhorn LH, Williams SD, Donohue JP, and Rowland RG: Pathologic findings at orchiectomy following chemotherapy for disseminated testicular cancer. J Clin Oncol 2:1025–1027, 1984.PubMedGoogle Scholar
  96. 96.
    Russell DS: The pinealoma: Its relationship to teratoma. J Path and Bacteriol 56:145–150, 1944.Google Scholar
  97. 97.
    Russell DS and Rubenstein LJ: Pineal neoplasms. In: Pathology of tumors of the nervous system, 4th ed. Baltimore: Williams and Wilkins, p 283–298, 1977.Google Scholar
  98. 98.
    Jenkin RD, Simpson WJK, and Keen CW: Pineal and suprasellar germinomas: Results of radiation therapy. J Neurosurg 48:99–107, 1978.PubMedGoogle Scholar
  99. 99.
    Sung DI, Harisiadis L, and Chang CH: Midline pineal tumors and suprasellar germinomas: Highly curable by radiation. Radiology 128:745–751, 1978.PubMedGoogle Scholar
  100. 100.
    Donat JF, Okazaki H, Gomez MR, Reagan TJ, Baker HL, and Laws ER: Pineal tumors: A 53 year experience. Arch Neurol 35:736–740, 1978.PubMedGoogle Scholar
  101. 101.
    Takeuchi J, Handa H, and Nagata I: Suprasellar germinoma. J Neurosurg 49:41–48,1978.PubMedGoogle Scholar
  102. 102.
    Parinaud H: Paralysis of the movement of consequence of the eyes. Brain 9:330–341, 1886.Google Scholar
  103. 103.
    DeGirolami U and Schmidek H: Clinicopathological study of 53 tumors of the pineal region. J Neurosurg 39:455–462, 1973.PubMedGoogle Scholar
  104. 104.
    Zimmerman RA, Bilaniuk LT, Wood JH, Bruce DA, and Schut L: Computed tomography on pineal, parapineal, and histologically related tumors. Radiology 137:669–677, 1980.PubMedGoogle Scholar
  105. 105.
    Onoyama Y, Ono K, Nakajima T, Hiraoka M, Abe M: Radiation therapy of pineal tumors. Radiology 130:757–760, 1979.PubMedGoogle Scholar
  106. 106.
    Suzuki J and Iwabachi T: Surgical removal of pineal tumors (pinealomas and teratomas). Experience in a series of 19 cases. J Neurosurg 23:565–571, 1965.PubMedGoogle Scholar
  107. 107.
    Chapman PH and Linggood RM: The management of pineal area tumors: A recent reappraisal. Cancer 46:1253–1257, 1980.PubMedGoogle Scholar
  108. 108.
    Wara WM, Fellows CF, Sheline GE, Wilson CB, and Townsend JJ: Radiation therapy of pineal tumors and suprasellar germinomas. Radiology 124:221–223, 1977.PubMedGoogle Scholar
  109. 109.
    Bradfield JS and Perez CA: Pineal tumors and ectopic pinealomas: Analysis of treatment and failures. Radiology 103:399–406, 1972.PubMedGoogle Scholar
  110. 110.
    Albrechtsen R, Klee JG, and Moller JE: Primary intracranial germ cell tumors including 5 cases of endodermal sinus tumor. Acta Path Microbiol Scand 80(Section A, Supplement 233):32–38, 1972.Google Scholar
  111. 111.
    Barlow CF: Case records of the Massachusetts General Hospital (#41–1974). N Engl J Med 291:837–843, 1974.Google Scholar
  112. 112.
    Bestle J: Extragonadal endodermal sinus tumors originating in the region of the pineal gland. Acta Pathol Microbiol Scan 74:214–22, 1968.Google Scholar
  113. 113.
    Eberts TJ and Ransburg RC: Primary intracranial endodermal sinus tumor: Case report. J Neurosurg 50:246–252, 1979.PubMedGoogle Scholar
  114. 114.
    Ho KH and Rassekh ZS: Endodermal sinus tumor of the pineal region: Case report and review of the literature. Cancer 44:1081–1086, 1979.PubMedGoogle Scholar
  115. 115.
    Stachura I and Mendelow H: Endodermal sinus tumor originating in the region of the pineal gland. Ultrastructural and immunohistochemical study. Cancer 45:2131–2137, 1980.PubMedGoogle Scholar
  116. 116.
    Yoshiki T, Itoh, T, Shirai T, Noro T, Tomino Y, Hamajima I, and Takeda T: Primary intracranial yolk sac tumors: Immunofluoroscent demonstration of alphafetoprotein synthesis. Cancer 37:2343–2348, 1976.PubMedGoogle Scholar
  117. 117.
    Prioleau G and Wilson CB: Endodermal sinus tumors of the pineal region: Case report. Cancer 38:2489–2493, 1976.PubMedGoogle Scholar
  118. 118.
    Hirano A and Matsui T: Vascular structures in brain tumors. Human Pathol 6:611–621, 1975.Google Scholar
  119. 119.
    Waggener JD and Beggs JL: Vasculature of neural neoplasms. Adv Neurol 15:27–49, 1976.PubMedGoogle Scholar
  120. 120.
    Broder LE and Rail DP: Chemotherapy of brain tumors. Prog Exp Tumor Res 17:373–399, 1972.PubMedGoogle Scholar
  121. 121.
    Ginsberg S, Kirschner J, Reich S, et al: Systemic chemotherapy for a primary germ cell tumor: A pharmacokinetic study. Cancer Treat Rep 65:477–483, 1981.PubMedGoogle Scholar

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© Martinus Nijhoff Publishers, Boston 1987

Authors and Affiliations

  • Eliot L. Friedman
  • Marc B. Garnick

There are no affiliations available

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