TN 8 (11-12)
DI 23022.965 Malignant Germ Cell Tumor
COMPASSIONATE ALLOWANCE INFORMATION
MALIGNANT GERM CELL TUMOR
Pediatric Malignant Germ Cell Tumor; Adult Malignant Germ Cell Tumor
Malignant Germ Cell Tumors (GCT) are malignant tumors that are formed by immature cells that begin in the reproductive cells of the testes or ovaries. These germ cells travel into the pelvis as ovarian cells or into the scrotal sac as testicular cells. These cells metastasize to other parts of the body and most commonly spread to the lungs, liver, lymph nodes, and central nervous system.
Adult germ cell tumors are usually in the testes or ovaries. There are germ cell tumors that grow outside of the gonads (very rare). These cells may grow in any location but generally settle in the brain (brain germ cell tumors), chest (chest germ cell tumors), or abdomen (abdominal germ cell tumors). Germ cell tumors in children usually form in the gonads, but can migrate to other areas. The exact cause of malignant GCT is unknown. Symptoms of malignant GCTs depend on the size and location of the tumor.
Mid chest GCT may cause symptoms of chest pain, breathing problems, cough, weight loss, nausea and fevers.
Lower back GCTs may present as a mass in the lower abdomen or buttocks.
Back of the abdomen GCTs may cause back pain or kidney problems and can sometimes be felt during a physical examination.
GCTs that occur in the brain interfere with the flow of fluid around the brain and spinal cord with symptoms of headaches, nausea, vomiting, memory loss, fatigue, gait disturbances, uncontrolled eye movements, and double vision.
DIAGNOSTIC TESTING, PHYSICAL FINDINGS, AND ICD-9-CM CODING
Diagnostic testing: biopsy, imaging studies
Physical findings: Physical examination of malignant GCT depend on the size and location of the tumor.
ONSET AND PROGRESSION
The prognosis for malignant germ cell tumors with distant or recurrent metastasis is poor. Congenital abnormalities affecting the central nervous system including spine, genitals, and urinary tract increase the risk for developing pediatric germ cell tumor malignancy, although these tumors are still extremely rare in children. Adult GCT generally occurs between 30- 40 years of age.
Treatment for malignant GCT depends on the type of tumor, the stage at diagnosis, and the age of the affected person. The primary treatment of most GCTs involves surgical removal of the tumor. Tumors with distant metastasis or recurrent following debulking surgery are treated with chemotherapy or radiation.
SUGGESTED PROGRAMMATIC ASSESSMENT*
Suggested MER for evaluation:
Suggested Listings for Evaluation:
Listing level severity must be documented.
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* Adjudicators may, at their discretion, use the Medical Evidence of Record or Listings suggested to evaluate the claim. However, the decision to allow or deny the claim rests with the adjudicator.