amphotericin-b and Dysgerminoma

A 20-year-old man was admitted to our institution complaining of gradually worsening motor weakness in the right extremities. On admission, the radiological examination revealed a mass located in the left parietal region. On April 4, 1988, a left fronto-parietal craniotomy was performed and the tumor was subtotally removed. The pathological findings of the surgical specimen confirmed no specific tumor, but the presence of a small mingled Candida glabrata supported the diagnosis of fungal granuloma. Amphotericin B (AmB) was administered intravenously for the later enlargement of the tumor. MRI 4 weeks after the beginning of this treatment demonstrated the tumor to be prominently decreased in size. At discharge 3 months later, there was no tumor except only a minimal one in the paraventricular region. However, the recurrence of the tumor was discovered again over the next 8 months. AmB was administered as before, but the tumor continued to be enlarged. In May, 1990, surgery was performed again, and the histological diagnosis was germinoma accompanied with considerable granulomatous reaction. Subsequently, local irradiation was given and complete remission was maintained up to the present time 8 months after irradiation. AmB is a polyene antifungal antibiotic, that has also been reported to enhance the response of antitumor drugs to some tumors on the basis of increased tumor cell permeability. Recent investigations revealed that AmB had immunoadjuvant properties mediated through activated lymphocytes and macrophages, which resulted in an increased host resistance against infectious diseases and even tumors in vivo or in vitro studies. We reported a rare case of intracranial germinoma which responded well to AmB probably through its own antitumor effect caused by immunoadjuvant properties. We discussed the possibility of AmB to be used as immunoadjuvant agent or in combination with other antitumor drugs for the effective treatment of some tumors.

Topics: Adult; Amphotericin B; Brain Neoplasms; Dysgerminoma; Humans; Infusions, Intravenous; Magnetic Resonance Imaging; Male

We report a rare case of germinoma with granulomatous reaction arising from the corona radiata. This 20-year-old man was admitted to our hospital complaining of progressive motor weakness on the right side. CT demonstrated a poorly demarcated high density area in the left corona radiata, which was heterogeneously enhanced after administration of contrast medium. Moreover, the continuity of the mass to the ventricular wall was confirmed on MRI. At the first operation, subtotal removal of the tumor was performed through a fronto-parietal craniotomy. The diagnosis for the specific neoplasm was not established histologically, but granuloma caused by fungal infection was the most likely cause of the lesion. We tried amphotericin B (AmB), and remission of the tumor was obtained. However, during the following 3 months, the size of the tumor gradually enlarged again. AmB was repeatedly administered, but this time the treatment was ineffective. Six months later, on May 21, 1990, the second operation was performed and histological examination revealed typical germinoma consisting of two-cell pattern. Subsequently, the patient underwent focal irradiation of 33 Gy to the tumor site, and the tumor completely disappeared. As intracranial germinomas are observed to be successfully cured by radiotherapy and/or chemotherapy, choice of the therapeutic management must be carefully determined according to the histological diagnosis, especially in young people. A variety of locations of germinomas and the accompanying granulomatous reactions could create some diagnostic confusion, so great care must be taken in the treatment of much intracranial germinomas.

Topics: Adult; Amphotericin B; Brain Neoplasms; Cerebral Cortex; Combined Modality Therapy; Diagnosis, Differential; Dysgerminoma; Granuloma; Humans; Magnetic Resonance Imaging; Male