DIAGNOSIS AND THERAPY OF MIXED PINEALOMAS CONSISTING IN PART OF SECRETING GERM-CELL TUMORS

Primary intracranial germ cell tumors are rare neurological diseases.S ecreting germ cell tumors that predominantly appear in the pineal regi on are characterized by elevated levels of beta-HCG and AFP in CSF. Ad equate diagnostic and therapeutic regimens of these tumors are still u nder debate.We present the case of a patient suffering from spinal met astasis of a secreting germ cell tumor with raised levels of beta-HCG in CSF.Six years before,a pineocytoma of intermediate differentiation had been diagnosed by stereotaxic biopsy. This demonstrates the import ance of an early detection of a germ cell neoplasm in case of midline- sized brain-tumors by evaluation of beta-HCG and AFP in CSF and serum. Today, different therapeutic strategies depending on the histological diagnosis are available and justify a high priority of a surgical tumo r biopsy. However, the value of stereotaxic procedures remains controv ersial. Recently published data gave evidence of a definite improved p rognosis of secreting CNS germ cell tumors following combined treatmen t with high-dose polychemotherapy,surgical resection and radiation of the tumor area. beta-HCG and AFP may serve as useful markers to enable follow-up of the disease.