levoleucovorin and Neoplasms--Germ-Cell-and-Embryonal

The growing teratoma syndrome is a recognized complication of metastatic nonseminomatous germ cell tumors of the testis and is managed surgically. It may also occur in intracranial nongerminomatous germ cell tumors.. The authors performed an English language computer search using the EMBASE data base (from January 1980 to December 1996) for pineal tumors, read all abstracts, and then selected all articles pertaining to germ cell tumors at this site.. The case history of a 19-year-old male who presented with a pineal nongerminomatous germ cell tumor, which was treated with chemotherapy, is reported. Despite normalization of raised tumor marker levels, the pineal mass enlarged during chemotherapy. This was excised and proved to be a mature teratoma. A review of the literature regarding this complication of intracranial germ cell tumors is also presented.. The authors believe this to be the first reported case of growing teratoma syndrome in the pineal gland of an adult patient, two previously reported cases occurred in children. The authors conclude that the pineal gland is an unusual but important site in which to recognize the growing teratoma syndrome.

Topics: Adult; Antineoplastic Combined Chemotherapy Protocols; Bleomycin; Cisplatin; Diagnosis, Differential; Endodermal Sinus Tumor; Etoposide; Humans; Leucovorin; Male; Methotrexate; Neoplasms, Germ Cell and Embryonal; Neoplasms, Second Primary; Pineal Gland; Syndrome; Teratoma; Vincristine

Two children with primary intracranial mixed germ cell tumors are described who were successfully treated by partial resection of the tumor followed by sequential combination chemotherapy without radiation therapy. The chemotherapy consisting of VP-16 and cisplatin alternating with vincristine, methotrexate, and bleomycin resulted in apparent complete response after 6 to 7 months of treatment. Disease-free remission has continued 30-34 months off therapy. A small residual mass in one patient continues to decrease in size on magnetic resonance imaging and is presumed to represent postsurgical change rather than malignant tumor. This report demonstrates that chemotherapy may be effective in primary germ cell tumors of the suprasellar and pineal regions and could be considered for primary treatment instead of radiotherapy.

Topics: Adolescent; Antineoplastic Combined Chemotherapy Protocols; Bleomycin; Brain Neoplasms; Child; Cisplatin; Combined Modality Therapy; Etoposide; Humans; Leucovorin; Male; Methotrexate; Neoplasms, Germ Cell and Embryonal; Postoperative Period; Vincristine

Primitive neuroectodermal tumors are found in the cerebrum of children and young adults. The are clinically highly malignant and have rapid course from diagnosis to death. Their microscopic pathology reveals 90% to 95% nondifferentiation, frequent mitoses, and small dark cells with no observable cytoplasm. This paper discusses the treatment of three children with this tumor with a combination of surgery irradiation, and combination chemotherapy. The results of this approach are compared with previous reports in the literature. The average survival in this series is 24 months versus approximately 8 months reported in the literature.

Topics: Adolescent; Antineoplastic Agents; Brain Neoplasms; Carmustine; Child; Dexamethasone; Drug Therapy, Combination; Female; Humans; Leucovorin; Male; Methotrexate; Neoplasms, Germ Cell and Embryonal; Procarbazine; Radiotherapy, High-Energy; Vincristine