Disseminated necrotizing leukoencephalopathy accompanied with multiple calcium deposits following antineoplastic and radiation therapy in a case of intracranial germ cell tumor: computerized tomographical study

A form of disseminated necrotizing leukoencephalopathy and the shaping process of calcification was observed by CT scan in a 9-year-old boy with intracranial germ cell tumor who had received systemic combined chemotherapy, brain radiation, and intraventricular administration of methotrexate and bleomycin for the meningeal involvement of tumor cells. He was admitted to our hospital complaining of hemiparesis and gait instability. Hormonal examination revealed abnormality of high serum HCG and testosterone. An initial CT scan showed a ring enhancing lesion in the right side of the caudate head. He received a course of irradiation, which was 5,000 rads locally, and combined chemotherapy using cisplatin, vinblastine and bleomycin for ectopic germ cell tumor. Unfortunately, consecutive CT examinations revealed that the tumor recurred with hormonal abnormality and ventricular seeding of tumor cells. Therefore, the patient received two courses of irradiation, which were each 3,000 rads locally, and intraventricular administration of methotrexate and bleomycin via an Ommaya tube at about one year intervals. However, 23 months after the first irradiation, a serial CT scan revealed an abnormal diffuse low density area in the deep white matter of the frontal lobe, predominantly the paraventricular region. Furthermore, 31 months after the first irradiation, a serial CT scan revealed fine and granular calcification in the above mentioned lesion. The Hounsfield number of high density areas was 103.00 in the round calcification of the left parietotemporal lobes. Finally, 34 months after the first irradiation, a serial CT scan revealed large round calcifications in the left temporal lobe and right occipital lobe. The patient died three years and six months after the initial symptoms.(ABSTRACT TRUNCATED AT 250 WORDS)