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Pineal Tumors



Germ Cell Tumor Staging


The following investigations are necessary to stage germ cell tumors:

  • Gadolinium enhanced MRI of the craniospinal axis
  • CSF cytology
  • Tumour markers in blood and CSF


There is no generally accepted staging system currently in use for germ cell tumors.

  • Most investigators use the M scale, or Chang staging system, that was devised for staging medulloblastoma. 
  • T-stage evaluation, a measure of the size of the tumor, is not usually used for germ cell tumors.  This is primarily due to their midline location.


Chang staging system for medulloblastoma:


No evidence of subarachnoid or hematogenous metastasis


Tumor cells found in cerebrospinal fluid


Intracranial tumor beyond primary site


Gross nodular seeding in spinal subarachnoid space


Metastasis outside the cerebrospinal axis (especially to bone marrow, bone)









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