Fluorescence in a cryptococcoma following administration of 5-aminolevulinic acid hydrochloride (Gliolan)

Solis, Waldo Gerard; Hansen, Mitchell A.

doi:10.1136/bcr-2017-219469

Cited by 6 publications

(4 citation statements)

References 11 publications

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“…Patients with C. gattii were less likely to report a significant past medical or surgical history, whereas those with C. neoformans were more likely to be HIV-infected, which is similar to findings from previous data [58,60]. A few patients reported social histories with established ecologic risk factors, including living in or traveling to Australia in the case of C. gattii [18,49], and exposure to birds and bird droppings in the case of C. neoformans [41,46]. Patients with cerebral cryptococcomas presented with a wide range of often non-specific symptoms and physical exam findings, from headache and altered mental status to vomiting, giddiness, word-finding difficulties, and cerebellar signs, which were more common among patients 50 years and older.…”

Section: Discussionsupporting

confidence: 83%

“…Improved methods to differentiate C. gattii from C. neoformans over the recent years have led to greater recognition of the global environmental distribution of C. gattii. Notably, all the cases where C. gattii was detected were published between 2005 and 2017 [18,21,31,35,40,48,49,51,52]. Due to resource limitations to perform species identification in many laboratories, it is likely that C. gattii may be responsible for some of the cases attributed to C. neoformans presented in this review.…”

Section: Discussionmentioning

confidence: 99%

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Cerebral Cryptococcomas: A Systematic Scoping Review of Available Evidence to Facilitate Diagnosis and Treatment

et al. 2022

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Background: Recommendations for managing patients with cerebral cryptococcomas are scarce across multiple clinical guidelines. Due to the deficiency of high-quality data coupled with an increasing number of at-risk patients, the purpose of this review is to describe the demographic characteristics, causative pathogen, intracranial imaging, surgical and/or pharmacological interventions, as well as outcomes of patients with cerebral cryptococcomas to improve recognition and management. Methods: We conducted a scoping review in accordance with the PRISMA guidelines using PubMed and Web of Science. Reports were included if the following details were presented: (1) site of infection; (2) treatment details which at least include the specific antifungal therapy administered, if applicable; and (3) patient outcome. Results: A total of 40 records representing 47 individual patients were included, of which the median age was 48.5 years, 75% were male, and 60% reported a significant past medical, surgical, or social history. C. neoformans was isolated more often than C. gattii (74% vs. 26%, respectively). Patients most often presented with headache, altered mental status and/or confusion, and vomiting occurring over a median of 30 days; though few were noted to have significant findings on physical examination. More than 50% of patients had a single cerebral cryptococcoma lesion, whereas perilesional edema was present in 73% of cases. Surgical intervention occurred in 49% of patients. An amphotericin B-based formulation was administered as “induction” therapy to 91% of patients, but combined with flucytosine or fluconazole in only 58%, for an overall median of 42 days. Fifty two percent of patients received “maintenance” therapy for a median of 126 days, in which fluconazole was most often used. Corticosteroids were administered to approximately 30% of patients for a median of 31.5 days. Overall, mortality was 34%. Conclusion: Based on our findings, management should include antifungal therapy for a minimum of 6 months with considerations for concomitant corticosteroids in the setting of perilesional edema, as well as surgical intervention. Emphasis should be placed on providing well-documented treatment details in future case reports and series to allow for the development of more concise evidence-based recommendations.

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Section: Discussionsupporting

confidence: 83%

Section: Discussionmentioning

confidence: 99%

Cerebral Cryptococcomas: A Systematic Scoping Review of Available Evidence to Facilitate Diagnosis and Treatment

et al. 2022

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“…Although brain abscesses show characteristic-restricted diffusion in the DWI sequence of MR, there are also some case reports of brain abscesses [ 40 ] that mimic GBM, such as Aggregatibacter and Cryptococcus gattii . [ 41 , 42 ] Exogenous 5-ALA has the potential to cause accumulation of PpIX, a precursor of heme, in all rapidly dividing cells. Diffuse large B-cell lymphoma, one of the predominant lymphomas, also showed typical images similar to GBM.…”

Section: Discussionmentioning

confidence: 99%

5-aminolevulinic enhanced brain lesions mimic glioblastoma: A case report and literature review

Chang,

Chen

2024

Medicine

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Rationale: Glioblastoma multiforme (GBM) is a highly malignant primary brain tumor for which maximal tumor resection plays an important role in the treatment strategy. 5-aminolevulinic (5-ALA) is a powerful tool in fluorescence-guided surgery for GBM. However, 5-ALA- enhancing lesion can also be observed with different etiologies. Patients concerns: Three cases of 5-ALA-enhancing lesions with etiologies different from glioma Diagnoses: The final diagnosis was abscess in 1 patient and diffuse large B-cell in the other 2 patients. Interventions: Three patients received 5-aminolevulinic acid-guided tumor resection under microscope with intraoperative neuromonitoring. Outcomes: All of our patients showed improvement or stable neurological function outcomes. The final pathology revealed etiologies different from GBM. Lessons: The 5-aminolevulinic acid fluorescence-guided surgery has demonstrated its maximal extent of resection and safety profile in patients with high-grade glioma. Non-glioma etiologies may also mimic GBM in 5-ALA-guided surgeries. Therefore, patient history taking and consideration of brain images are necessary for the interpretation of 5-ALA-enhanced lesions.

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“…79 -81 Considering non-oncological settings, 5-ALA fluorescence has been observed in multiple sclerosis, 82 neurodegenerative diseases 71,83 and infectious conditions (several bacterial species could elaborate porphyrin precursor like cofactor of growth, explaining the reason behind bacterial abscesses macroscopic fluorescence). 69,70,84,85 It is important to underline that all the oncological and non-oncological settings share a common characteristic consisting in a high number of immune cells that could show different degrees of fluorescence due to 5-ALA metabolism and uptake.…”

Section: -Ala False Positive Fluorescencementioning

confidence: 99%

Fluorescence-Guided Surgery for High-Grade Gliomas: State of the Art and New Perspectives

Palmieri

Cofano

Salvati

et al. 2021

Technol Cancer Res Treat

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High-grade gliomas are aggressive tumors that require multimodal management and gross total resection is considered to be the first crucial step of treatment. Because of their infiltrative nature, intraoperative differentiation of neoplastic tissue from normal parenchyma can be challenging. For these reasons, in the recent years, neurosurgeons have increasingly performed this surgery under the guidance of tissue fluorescence. Sodium fluoresceine and 5-aminolevulinic acid represent the 2 main compounds that allow real-time identification of residual malignant tissue and have been associated with improved gross total resection and radiological outcomes. Though presenting different profiles of sensitivity and specificity and further investigations concerning cost-effectiveness are need, Sodium fluoresceine, 5-aminolevulinic acid and new phluorophores, such as Indocyanine green, represent some of the most important tools in the neurosurgeon’s hands to achieve gross total resection.

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Fluorescence in a cryptococcoma following administration of 5-aminolevulinic acid hydrochloride (Gliolan)

Cited by 6 publications

References 11 publications

Cerebral Cryptococcomas: A Systematic Scoping Review of Available Evidence to Facilitate Diagnosis and Treatment

Cerebral Cryptococcomas: A Systematic Scoping Review of Available Evidence to Facilitate Diagnosis and Treatment

5-aminolevulinic enhanced brain lesions mimic glioblastoma: A case report and literature review

Fluorescence-Guided Surgery for High-Grade Gliomas: State of the Art and New Perspectives

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