Germ cell tumors originate in the primordial germ cells, which may undergo either germino-matous or embryonic differentiation. They are biologically diverse and range from benign teratomas to the malignant germinomas and non-germinomatous germ cell tumors. These tumors are located primarily in the midline, with the majority occurring outside the CNS. Approximately 5% of germ cell tumors in children occur within the CNS, most frequently in the pineal and suprasellar regions  (Fig. 28.4). Germinomas account for approximately 60% of these tumors, teratomas 30% and the malignant embryonal carcinoma, choriocarcinomas and endodermal sinus tumors approximately 10%. The non-germinomatous malignant germ cell tumors are often characterized by secretion of either beta HCG, alphafetoprotein or both. Significant elevation of one or both of these tumor markers, in association with a tumor located in the characteristic region, are sufficient to make a diagnosis. However, in the absence of such tumor marker elevation, tumor biopsy is required.
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The term vaginitis is one that is applied to any inflammation or infection of the vagina, and there are many different conditions that are categorized together under this ‘broad’ heading, including bacterial vaginosis, trichomoniasis and non-infectious vaginitis.