Incidence

The incidence of CNS metastases in patients with extracranial germ cell tumors varies, depending on the cell type and primary site of the tumor (Tables 17-1 and 17-2). Brain metastases are associated most commonly with the following clinical situations:

1. Nonseminomatous germ cell tumor (NSGCT)

arising in the testis or retroperitoneum (versus tumor in the mediastinum)

2. Choriocarcinoma

3. High levels of serum human chorionic gonadotropin

4. Pulmonary metastases

5. NSGCT (versus seminoma)

In reported autopsy series, brain metastases from germ cell tumors are surprisingly common although it should be noted that many of these series antedated the availability of curative treatment strategies for most patients. Earle1 found cerebral metastases in 32.1% of 27 cases of testicular cancer in a series of 3,946 necropsies undertaken at the Los Angeles Department of Veterans Affairs between 1948 and 1952. Bredael and colleagues2-4 reported on autopsy experience in 154 of approximately 1,300 cases of germ cell tumor treated at Memorial Sloan-Kettering Cancer Center between 1949 and 1978. Of these, 120 cases included postmortem examination of the CNS, and cerebral metastases were found in 38 (31%) of these cases. In contrast, Cox reported on a series of 24 patients with mediastinal germ cell tumors (GCTs) treated at Walter Reed Hospital between 1949 and 1971 and found no cases with CNS metastases.5

Within case series of extracranial GCTs when the predominant definition of CNS involvement is based on clinical and radiologic diagnosis, CNS metastases occur in 2.5 to 12.5% of cases6-13 Kaye and colleagues6 reported the first sizable clinical series of this type (see Table 17-1). Their findings included the following:

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