Pitfalls of a neuroendoscopic biopsy of intraventricular germ cell tumors

Pitfalls of a neuroendoscopic biopsy of intraventricular germ cell tumors.
Kinoshita Y, et al. World Neurosurg. 2017.
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OBJECTIVE: A neuroendoscopic biopsy has become common for the diagnosis of ventricular tumors. However, its utility in patients with germ cell tumors (GCTs) has not been well discussed. We examined the usefulness and pitfalls of neuroendoscopic biopsies of intraventricular GCTs at a single institution.
METHODS: We retrospectively studied 21 consecutive patients diagnosed with GCT by a neuroendoscopic biopsy of the ventricular region via the lateral ventricle. We examined the localization of tumors, histological diagnoses using biopsies, surgical complications, and consistency of the diagnosis at the latest follow-up.
RESULTS: Tumor specimens were obtained from a pineal lesion (n=20), neurohypophysial lesion (n=5), and lateral ventricular wall lesion (n=2). In five patients, the specimens were obtained from multiple areas. The initial diagnoses were pure germinoma (n=16), immature teratoma (n=1), yolk sac tumor (n=1), and mixed GCT (n=3). Six of 21 patients needed a second transcranial removal of enhanced residual lesions in the course of the treatment. A discrepancy in the histological diagnosis between two surgeries occurred in three patients: all three patients had a new diagnosis of teratoma component following transcranial surgery. No postoperative mortality or permanent morbidity related to the neuroendoscopic procedures was noted.
CONCLUSION: Neuroendoscopic biopsies are safe and useful for obtaining reliable histological diagnoses in the management of GCTs. However, for GCTs with mixed histology, biopsies are susceptible to diagnostic errors, especially missing detecting a component of teratoma.
Copyright © 2017 Elsevier Inc. All rights reserved.
PMID 28711530 [PubMed – as supplied by publisher]
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