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Detection of germinoma cells in cerebrospinal fluid using Oct4 immunocytochemistry: a case report

Cerebrospinal fluid (CSF) cytology in conjunction with neuroimaging is the gold standard for detecting the neuraxial spread of central nervous system (CNS) neoplasms. Intracranial germ cell tumours (GCTs), representing approximately 2.0–3.0% of all primary CNS neoplasms, are most commonly located in the pineal/suprasellar region. They are divided into germinomas, non-germinomatous GCTs (NGGCTs) and mature teratomas. The prognosis of patients with NGGCTs remains poor, with a median survival of fewer than 2 years. In contrast, germinomas are usually sensitive to chemoradiotherapy and the prognosis is, therefore, good, with many series having reported survival rates exceeding 90% at 5 years after diagnosis and treatment. Therefore, brain and spine magnetic resonance imaging (MRI), measurement of CSF/serum tumour markers and CSF cytology are essential components of the diagnostic evaluation. However, in terms of cytology, given the relatively low frequency of tumour cells in the CSF and the low cellularity of most specimens, cytopathologists often encounter difficulties when interpreting CSF specimens. Herein, we present a case of intracranial germinoma with spinal dissemination for which CSF cytology diagnosis was possible using immunocytochemistry for Oct4. Case history