TN 8 (11-12)

DI 23022.965 Malignant Germ Cell Tumor

COMPASSIONATE ALLOWANCE INFORMATION

MALIGNANT GERM CELL TUMOR

ALTERNATE NAMES

Pediatric Malignant Germ Cell Tumor; Adult Malignant Germ Cell Tumor

DESCRIPTION

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.

ICD-9: 183.00

186.00

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

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:

  • Clinical history and examination that describes the diagnostic features of the impairment.

  • Pathology report of biopsy specimen.

  • Results of imaging.

Suggested Listings for Evaluation:

DETERMINATION

LISTING

REMARKS

Meets Listing

13.23E2

13.25

113.03

Listing level severity must be documented.

Medical Equals

  

* 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.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0423022965
DI 23022.965 - Malignant Germ Cell Tumor - 11/30/2012
Batch run: 11/30/2012
Rev:11/30/2012