[Recurrence with tumor bleeding in a patient with malignant astrocytoma during the treatment with intracranial injection of lymphokine-activated killer cells--a case report].
A 22-year-old woman harboring recurrent malignant astrocytoma presented with intracranial hypertension by tumor hemorrhage during repeated administration of lymphokine-activated killer (LAK) cells via Ommaya's reservoir. She first suffered from the tumor located at the right occipital lobe at the age of 13. The tumor regressed completely by subtotal removal of the tumor, followed by external irradiation. Nine years later, however, the occipital tumor recurred and was subtotally resected. Pathological diagnosis was astrocytoma grade 3. Postoperatively, LAK cells induced from her peripheral blood lymphocytes incubated with interleukin-2 and anti-CD3 antibody were injected into the tumor cavity via Ommaya's reservoir for eight times. At the end of the LAK therapy, the tumor regrew with massive hemorrhage in the tumor cavity causing intracranial hypertension. At the reoperation, thick granulation tissue covered the surface of the recurrent tumor and dense deposits of clot were noted around the tip of the Ommaya's tube. Histologically the superficial layer of the tumor was infiltrated with macrophages and lymphocytes, mostly CD3-positive T cells, accompanied with capillary hyperplasia. Viable astrocytoma cells were abundant beneath the granulation layer. It should be considered that in local LAK therapy granulation tissue formation with hypervascularization at the surface of the tumor cavity may lead to tumor bleeding as well as resistance to the treatment.
Department of Neurosurgery, National Cancer Center Hospital, Tokyo, Japan.
M
M
Nagane
H
H
Oyama
S
S
Shibui
K
K
Nomura
D000328:Adult; D001932:Brain Neoplasms / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D002543:Cerebral Hemorrhage / Q000209:etiology*; D005260:Female; D005909:Glioblastoma / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D006801:Humans; D016219:Immunotherapy, Adoptive / Q000009:adverse effects*; D015979:Killer Cells, Lymphokine-Activated / Q000637:transplantation*; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local