scholarly journals Leptomeningeal Carcinomatosis From Carcinoma of Unknown Primary in a Young Patient: A Case Report and a Literature Review

2019 ◽  
Vol 7 ◽  
pp. 232470961986938 ◽  
Author(s):  
Leila Moosavi ◽  
Carlos D’Assumpcao ◽  
Jonathan Bowen ◽  
Arash Heidari ◽  
Everardo Cobos
Keyword(s):  
Alkaline Phosphatase ◽  
Germ Cell ◽  
Germ Line ◽  
Locally Advanced ◽  
Cervical Lymphadenopathy ◽  
Leptomeningeal Metastasis ◽  
Leptomeningeal Carcinomatosis ◽  
Unknown Primary ◽  
Placental Alkaline Phosphatase ◽  
Carcinoma Of Unknown Primary

Leptomeningeal carcinomatosis, leptomeningeal meningitis, or, as referred here, leptomeningeal metastasis (LM), is a rare but frequently fatal complication seen in advanced stage of cancer either locally advanced or after a metastasis of a known primary cancer. We present a rare and uncommon case of leptomeningeal metastases from carcinoma of unknown primary. A 32-year-old female was diagnosed with LM; however, no known primary carcinoma was identified after 2 separate biopsies. The first biopsy of the right pre-tracheal lymph node showed poorly differentiated pan-keratin (AE1 and AE3) and placental alkaline phosphatase with the possibility of germ cell origin. Second cytology of cervical lymphadenopathy was remarkable for cytokeratin 7 and 20, placental alkaline phosphatase, and CDX2 suggestive of germ line tumor with both mucinous ovarian and gastrointestinal carcinomas. Unfortunately, the LM progressed rapidly despite multiple cycles of germ cell origin directed systemic and intrathecal chemotherapy, and the patient opted for hospice care without getting a chance to identify the primary source.

scholarly journals GCT-06. DIAGNOSIS OF A RARE CASE OF RECURRENT GERM CELL TUMOR BY CSF PLACENTAL ALKALINE PHOSPHATASE PRESENTING WITH DIFFUSE INTRAAXIAL ABNORMALITY IN THE LOWER BRAINSTEM

2020 ◽  
Vol 22 (Supplement_3) ◽  
pp. iii329-iii329
Author(s):  
Hiroki Yamada ◽  
Tomohiro Abiko ◽  
Hirokazu Fujiwara ◽  
Kazunari Yoshida ◽  
Hikaru Sasaki
Keyword(s):  
Alkaline Phosphatase ◽  
Germ Cell ◽  
Germ Cell Tumor ◽  
Rare Case ◽  
Cervical Spinal Cord ◽  
Germ Cell Tumors ◽  
Cell Tumor ◽  
Placental Alkaline Phosphatase ◽  
Steroid Pulse ◽  
Platinum Based Chemotherapy

Abstract INTRODUCTION Germ cell tumors in the central nervous system (CNS) typically arise either at suprasellar and/or pineal region, and occasionally at basal ganglia. We report a case of diagnostically challenging, recurrent germ cell tumor presented with diffuse intraaxial abnormality in and across the lower brainstem, which was diagnosed by the elevated placental alkaline phosphatase (PLAP) level in cerebrospinal fluid (CSF). CASE DESCRIPTION: A 28-year-old man had been treated by chemoradiotherapy at the previous hospital for bifocal suprasellar and pineal lesions with the provisional diagnosis of germinoma without histological confirmation. Three years later, he presented with progressive weakness of bilateral extremities for weeks. Magnetic resonance imaging showed a diffuse, bilaterally symmetric high intensity lesion on T2-weighted image with slight contrast enhancement across the ventral side of the medulla oblongata to the upper cervical spinal cord. Serum and CSF hCG, hCG-β, and AFP were all negative. Since the image findings were atypical for recurrent germ cell tumor, some kind of myelitis was initially suspected. Therefore, steroid pulse therapy was administered. However, the patient’s symptom was still gradually progressing. Then, the CSF PLAP turned out to be positive, indicating the recurrence of germinoma. Accordingly, platinum-based chemotherapy was administered, and the imaging findings, patient’s symptoms, and CSF PLAP began to improve. The patient is to be treated with radiotherapy following chemotherapy. CONCLUSION We report a rare case of CNS germ cell tumor that presented with diffuse intraaxial lesion in the lower brainstem in which examination of CSF PLAP was extremely useful.

Enzyme immunoassay of human placental and germ-cell alkaline phosphatase in serum

1990 ◽  
Vol 36 (10) ◽  
pp. 1793-1799 ◽  
Author(s):  
P G Hendrix ◽  
M F Hoylaerts ◽  
E J Nouwen ◽  
M E De Broe
Keyword(s):  
Alkaline Phosphatase ◽  
Germ Cell ◽  
Incubation Temperature ◽  
Molecular Form ◽  
Final Concentration ◽  
Placental Alkaline Phosphatase ◽  
Antibody Affinity ◽  
Lower Affinity ◽  
Tissue Extracts ◽  
Cancer Tissues

Abstract Placental alkaline phosphatase (placental ALP, PLAP) and germ-cell ALP (GCAP, also known as placental-like ALP), expressed in gonadal cancer tissues, are potential tumor markers. Four monoclonal antibodies, raised against PLAP and recognizing different epitopes, were selected to study the influence of the following variables on the accuracy of PLAP and GCAP measurement: phenotype, molecular form, and glycation pattern of PLAP and GCAP; incubation temperature; and interferences by serum during immunobinding. Nine GCAP phenotypes were identified, interacting with each antibody at a lower affinity than was seen for the more common PLAP phenotypes. Antibody affinity is higher for the free hydrophilic dimeric forms of PLAP and GCAP, and is not influenced by the degree of glycation. In serum or tissue extracts, measurement of PLAP or GCAP is most nearly accurate when immunoincubations are performed at 37 degrees C, with use of antibodies 327 and 7E8, respectively. In addition, correct measurements are achieved only when, during immunobinding, serum is incubated with an equal volume of deoxycholate (9 g/L final concentration).

Simple prognostic model to predict survival in patients with undifferentiated carcinoma of unknown primary site.

1995 ◽  
Vol 13 (7) ◽  
pp. 1720-1725 ◽  
Author(s):  
A van der Gaast ◽  
J Verweij ◽  
A S Planting ◽  
W C Hop ◽  
G Stoter
Keyword(s):  
Alkaline Phosphatase ◽  
Prognostic Factors ◽  
Median Survival ◽  
Performance Status ◽  
Primary Site ◽  
Survival Duration ◽  
Unknown Primary ◽  
Unknown Primary Site ◽  
Carcinoma Of Unknown Primary ◽  
Median Survival Duration

PURPOSE We performed this study to identify prognostic factors in a subgroup of patients with carcinoma of unknown primary site treated with cisplatin combination chemotherapy. PATIENTS AND METHODS Seventy-nine patients with poorly differentiated adenocarcinoma or undifferentiated carcinoma of unknown primary site were treated on two consecutive phase II chemotherapy protocols. The first protocol consisted of treatment with 3-week courses of cisplatin, etoposide, and bleomycin (BEP). In the second protocol, cisplatin was administered weekly combined with oral administration of etoposide (DDP/VP). To identify prognostic factors, univariate and multivariate analyses were conducted. RESULTS In the univariate analysis, performance status, histology, liver or bone metastases, and serum levels of alkaline phosphatase and AST were significant variables to predict survival. In the multivariate analysis, performance status and alkaline phosphatase were the most important prognostic factors. CONCLUSION Good-prognosis patients had a performance score of 0 (World Health Organization [WHO]) and an alkaline phosphatase serum level less than 1.25 times the upper limit of normal (N). These patients had a median survival duration greater than 4 years. Intermediate-prognosis patients were characterized by either a WHO performance status < or = 1 or an alkaline phosphatase level > or = 1.25 N. These patients had a median survival duration of 10 months and a 4-year survival rate of only 15%. The poor-prognosis group had both a WHO performance status > or = 1 and an alkaline phosphatase level > or = 1.25 N. These patients had a median survival duration of only 4 months and none survived beyond 14 months. Treatment strategies for these three groups are discussed. It is suggested that this prognostic model be validated in other patients series.

scholarly journals Gly429 is the major determinant of uncompetitive inhibition of human germ cell alkaline phosphatase by l-leucine

1991 ◽  
Vol 274 (1) ◽  
pp. 91-95 ◽  
Author(s):  
C Hummer ◽  
J L Millán
Keyword(s):  
Alkaline Phosphatase ◽  
Catalytic Activity ◽  
Germ Cell ◽  
Major Determinant ◽  
Site Directed Mutagenesis ◽  
Directed Mutagenesis ◽  
Placental Alkaline Phosphatase ◽  
Uncompetitive Inhibition ◽  
Primary Determinant ◽  
Human Placental Alkaline Phosphatase

The catalytic activity of human placental alkaline phosphatase (PLAP) and germ cell alkaline phosphatase (GCAP) can be inhibited, through an uncompetitive mechanism, by L-Phe. GCAP is also selectively inhibited by L-Leu. Site-directed mutagenesis of five of the 12 residues which are different in PLAP and GCAP revealed that Gly429 is the primary determinant of GCAP inhibition by L-Leu, and Ser84 and Leu297 play a modulatory role in the inhibition.

scholarly journals Precise detection of the germinomatous component of intracranial germ cell tumors of the basal ganglia and thalamus using placental alkaline phosphatase in cerebrospinal fluid

2021 ◽  
Author(s):  
Kentaro Chiba ◽  
Yasuo Aihara ◽  
Takakazu Kawamata
Keyword(s):  
Alkaline Phosphatase ◽  
Cerebrospinal Fluid ◽  
Basal Ganglia ◽  
Germ Cell ◽  
Sensitivity And Specificity ◽  
Germ Cell Tumors ◽  
Decisive Role ◽  
Target Tissue ◽  
Placental Alkaline Phosphatase ◽  
Intracranial Germ Cell Tumors

Abstract Purpose: The disadvantages of biopsy for lesions in the basal ganglia and thalamus include a risk of various complications, difficulty in selecting the target tissue in some cases due to indistinct neuroimaging findings and limited availability of sample tissue. Placental alkaline phosphatase (PLAP) plays a decisive role in the diagnosis and management of intracranial germ cell tumors (IGCTs) in the basal ganglia and thalamus. The present study aimed to demonstrate the ability, specificity, and optimal use of PLAP values obtained from cerebrospinal fluid (CSF).Methods: Twenty patients with lesions in the basal ganglia and thalamus were enrolled in this study: 11 had IGCTs and 9 had non-IGCTs. The values of PLAP and other established tumor markers in the CSF were measured in all patients before treatment.Results: The mean follow-up period was 76.0 months (range, 3–168) for all lesions. PLAP was elevated in all 11 patients with IGCTs in the basal ganglia or thalamus, whereas none of the patients with non-IGCT exhibited elevated PLAP. Thus, the sensitivity and specificity of PLAP were both 100%.Conclusion: Our data demonstrated that the PLAP value can specifically identify the germinomatous component even in cases of IGCTs in the basal ganglia or thalamus with high sensitivity and specificity. PLAP is undoubtedly beneficial for the safe and timely detection of the germinomatous component of IGCTs in the basal ganglia and thalamus, because reliance on PLAP measurement enables us to avoid invasive surgical procedures and facilitates the prompt initiation of chemoradiation therapy.

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