Pineal germinoma serum and cerebrospinal fluid biomarkers [Neurosurgery Wiki]

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====== Pineal germinoma serum and cerebrospinal fluid biomarkers ======

see [[Germ cell tumor biomarker]]s

[[Choriocarcinoma]]s and [[germinoma]]s are associated with elevated [[β-hCG]]
((Yamamoto I, Kageyama N. Microsurgical anatomy of the pineal region. J Neurosurg. 1980. August;53(2):205-221. doi: 10.3171/jns.1980.53.2.0205.))
((Bruce JN, Connolly ES, Sonabend AM. Pineal cell and germ cell tumors. In: Kaye AH, Laws ER, eds. Brain Tumors. 3rd ed. New York, NY: Elsevier Limited; 2012.))
((Allen JC, Nisselbaum J, Epstein F, Rosen G, Schwartz MK. Alphafetoprotein and human chorionic gonadotropin determination in cerebrospinal fluid. An aid to the diagnosis and management of intracranial germ-cell tumors. J Neurosurg. 1979. September;51(3):368-374.))
((Haase J, Børgaard-Pedersen B.. Alpha-feto-protein (AFP) and human chorionic gonadotropin (HCG) as biochemical markers of intracranial germ-cell tumours. Acta Neurochir (Wien). 1979;50(1-2):67-69. doi: 10.1007/BF01813551.))
((Neuwelt EA, Smith RG. Presence of lymphocyte membrane surface markers on “small cells” in a pineal germinoma. Ann Neurol. 1979. August;6(2):133-136. doi: 10.1002/ana.410060211.))
((Wilson ER, Takei Y, Bikoff WT, O'Brien MS, Tindall GT, Boehm WM. Abdominal metastases of primary intracranial yolk sac tumors through ventriculoperitoneal shunts: report of three cases. Neurosurgery. 1979. September;5(3):356-364.))
((Arita N, Ushio Y, Hayakawa T, et al. . Serum levels of alpha-fetoprotein, human chorionic gonadotropin and carcinoembryonic antigen in patients with primary intracranial germ cell tumors. Oncodev Biol Med. 1980;1(4-5):235-240.))
((Jooma R, Kendall BE. Diagnosis and management of pineal tumors. J Neurosurg. 1983. May;58(5):654-665. doi: 10.3171/jns.1983.58.5.0654.))
((Bamberg M, Metz K, Alberti W, Heckemann R, Schulz U. Endodermal sinus tumor of the pineal region. Metastases through a ventriculoperitoneal shunt. Cancer. 1984. Sep 1;54(5):903-906.))
((Jennings MT, Gelman R, Hochberg F. Intracranial germ-cell tumors: natural history and pathogenesis. J Neurosurg. 1985. August;63(2):155-167.))
((Page R, Doshi B, Sharr MM. Primary intracranial choriocarcinoma. J Neurol Neurosurg Psychiatry. 1986. January;49(1):93-95.))
((Russel DS, Rubinstein LJ. Tumors and tumor like lesions of maldevelopmental origin. Pathology of Tumors of the Nervous System. 5th ed London, England; Edward Arnold: 1989;693-695.));
nevertheless, β-hCG levels in [[germinoma]]s are inconsistent, and germinomas with elevated β-hCG may have a poor prognosis
((Uematsu Y, Tsuura Y, Miyamoto K, Itakura T, Hayashi S, Komai N. The recurrence of primary intracranial germinomas. J Neuro-Oncol. 1992. July;13(3):247-256. doi: 10.1007/BF00172477.))
((Yoshida J, Sugita K, Kobayashi T, et al. . Prognosis of intracranial germ cell tumours: effectiveness of chemotherapy with cisplatin and etoposide (CDDP and VP-16). Acta Neurochir (Wien). 1993;120(3-4):111-117.))((Utsuki S, Kawano N, Oka H, Tanaka T, Suwa T, Fujii K. Cerebral germinoma with syncytiotrophoblastic giant cells: feasibility of predicting prognosis using the serum hCG level. Acta Neurochir (Wien). 1999;141(9):975-977. doi: 10.1007/s007010050404.))
((Utsuki S, Oka H, Tanaka S, Tanizaki Y, Fujii K. Long-term outcome of intracranial germinoma with hCG elevation in cerebrospinal fluid but not in serum. Acta Neurochir (Wien). 2002. November;144(11):1151-1154; discussion 1154-1155. doi: 10.1007/s00701-002-1008-4.)).

[[Germinoma]]s are also associated with elevated [[lactate dehydrogenase]] and [[placental alkaline phosphatase]]
((Bruce JN, Connolly ES, Sonabend AM. Pineal cell and germ cell tumors. In: Kaye AH, Laws ER, eds. Brain Tumors. 3rd ed. New York, NY: Elsevier Limited; 2012.))
((Metcalfe S, Sikora K. A new marker for testicular cancer. Br J Cancer. 1985. July;52(1):127-129.))
((Shinoda J, Miwa Y, Sakai N, et al. . Immunohistochemical study of placental alkaline phosphatase in primary intracranial germ-cell tumours. J Neurosurg. 1985. November;63(5):733-739.)).
----
[[Germ cell tumor]]s in the brain release hormones directly into the [[CSF]]. Comparing [[CSF]] and serum [[β-hCG]] levels is a particularly important step in the workup of a [[pineal tumor]], as patients with metastatic disease do not benefit from resection of the primary tumor. Accordingly, an important workup step before obtaining CSF is a systemic assessment; if the systemic assessment reveals a primary site, CSF sampling is not necessary
((Carr C, O'Neill BE, Hochhalter CB, Strong MJ, Ware ML. Biomarkers of Pineal
Region Tumors: A Review. Ochsner J. 2019 Spring;19(1):26-31. doi:
10.31486/toj.18.0110. Review. PubMed PMID: 30983898; PubMed Central PMCID:
PMC6447205.
)).

In a [[review]], Carr et al. searched [[PubMed]] using the following keywords: biomarkers, [[germ cell tumor]]s, [[germinoma]], [[melatonin]], [[pineal]], [[pineal gland]], [[pineal neoplasm]], [[pinealoma]], [[pineal parenchymal cell tumor]], [[pineal region]], and [[pineal tumor]]. 

They limited the search to full-text English articles and identified other relevant sources from the reference lists of identified articles. 

Serum and CSF [[biomarker]] assays have a role in cases of suspected [[pineal germ cell tumor]] or parenchymal neoplasms. Biomarkers including [[alpha-fetoprotein]], [[beta human chorionic gonadotropin]], and [[placental alkaline phosphatase]] inform diagnosis and treatment and are important for monitoring [[germ cell tumor]] response to treatment. No biomarkers are currently available that inform the diagnosis or treatment of [[pineal parenchymal tumor]]s, although [[melatonin]] assays may have a role in monitoring response to treatment. 

Serum and CSF [[biomarker]]s in conjunction with clinical and radiographic evidence of a [[pineal region tumor]] can inform the decision whether to undertake [[stereotactic biopsy]] or surgical [[excision]] or whether to proceed straight to medical treatment
((Carr C, O'Neill BE, Hochhalter CB, Strong MJ, Ware ML. Biomarkers of Pineal
Region Tumors: A Review. Ochsner J. 2019 Spring;19(1):26-31. doi:
10.31486/toj.18.0110. Review. PubMed PMID: 30983898; PubMed Central PMCID:
PMC6447205.
)).
----
[[Germ cell tumor]]s may secrete measurable oncoproteins such as [[Beta human chorionic gonadotropin]] (HCG) and [[Alpha fetoprotein]] in the serum or CSF. Pure germinomas, by definition, only secrete HCG. The α-fetoprotein levels in the serum and CSF are normal.