Human chorionic gonadotrophin in CSF, not serum, predicts outcome in germinoma

Objectives-Some intracranial germinomas, which may contain syncytiotrophobl astic giant cells (STGCs), are associated with a mildly to moderately incre ased human chorionic gonadotropin (HCG) concentration in serum, and patient s with such germinomas are thus treated more aggressively than those with " pure" germinoma. However, the patients with germinoma and detectable HCG in CSF but not in serum have been classified and treated similarly to those w ith "pure" germinomas. The outcome of these patients and the relavance of H CG in the CSF were analysed. Methods-The outcomes of patients with germinoma and increased serum HCG con centration (n=7) were compared with those of patients having detectable HCG titre in the CSF but not in the serum (n=5). Results-Both groups in our series received similar treatments and also show ed similar recurrence rates. The 40% recurrence rate in the group with HCG only in CSF did not correspond to the rate typical for "pure" germinoma: th ese rumours would be expected to have a better outcome. An additional patie nt whose CSF HCG were raised without increased serum HCG at recurrence is p resented. Conclusions-It is recommended that patients with an increased HCG concentra tion in CSF should be considered to have "HCG producing germinoma", and the y should be treated and followed up accordingly.