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Gajaria PK, Shenoy AS, Baste BD, Goel NA. Glioblastoma Occurring as Second Primary in a Treated Case of Diffuse Large B-Cell Lymphoma. Asian J Neurosurg 2021; 16:178-182. [PMID: 34211890 PMCID: PMC8202363 DOI: 10.4103/ajns.ajns_230_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 09/06/2020] [Accepted: 10/14/2020] [Indexed: 11/04/2022] Open
Abstract
Glioblastoma as second primary malignancy (SPM) has been reported after prostate cancer, meningiomas, Hodgkin's lymphoma. We report an extremely rare case of glioblastoma as SPM, occurring after remission of diffuse large B-cell lymphoma (DLBCL). Fifty-year-old male presented with loss of consciousness followed by right-sided weakness. He was treated with chemotherapy for DLBCL of the cervical lymph nodes, 5 years back. Present scans revealed well-defined intra-axial lesion in the left parietal lobe, suggestive of central nervous system (CNS) involvement by lymphoma. Left parieto-occipital craniotomy was performed and microscopic examination revealed the tumor to be Glioblastoma, WHO Grade IV. The tumor cells were positive for glial fibrillary acid protein and negative for leucocyte common antigen. He was treated by radiotherapy and temozolomide. Pathologic examination is a must for CNS lesions. Had it not been for the biopsy, the patient would have been treated as a recurrence of CNS lymphoma by chemotherapy and would have probably succumbed.
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Affiliation(s)
- Pooja Kamlesh Gajaria
- Department of Pathology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Asha Sharad Shenoy
- Department of Pathology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Balaji Devrao Baste
- Department of Pathology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Naina Atul Goel
- Department of Pathology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
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Kajitani T, Kanamori M, Saito R, Watanabe Y, Suzuki H, Watanabe M, Kure S, Tominaga T. Three case reports of radiation-induced glioblastoma after complete remission of acute lymphoblastic leukemia. Brain Tumor Pathol 2018; 35:114-122. [PMID: 29666969 DOI: 10.1007/s10014-018-0316-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 04/10/2018] [Indexed: 11/28/2022]
Abstract
Radiation therapy is sometimes performed to control intracranial acute lymphoblastic leukemia (ALL), but may lead to radiation-induced malignant glioma. The clinical, radiological, histological, and molecular findings are described of three cases of radiation-induced glioblastoma after the treatment for ALL. They received radiation therapy at age 6-8 years. The latency from radiation therapy to the onset of radiation-induced glioblastoma was 5-10 years. Magnetic resonance imaging demonstrated diffuse lesions with multiple small enhanced lesions in all cases. Histological examination showed that the tumors consisted of mainly small round astrocytic atypical cells in one case, and astrocytic atypical cells with elongated cytoplasm and nuclear pleomorphism with small cell component in two cases. Microvascular proliferation was present in all cases. Immunohistochemical analysis for B-Raf V600E, and mutational analysis for the isocitrate dehydrogenase (IDH) 1, IDH2, and H3F3A gene revealed the wild-type alleles in all three cases. The integrated diagnoses were IDH wild-type glioblastoma, and local irradiation and concomitant temozolomide were performed. After the initial treatment, significant shrinkage of the diffuse lesion and enhanced lesion was found in all cases. Radiation-induced glioblastoma occurring after the treatment for ALL had unique clinical, radiological, histological, and molecular characteristics in our three cases.
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Affiliation(s)
- Takumi Kajitani
- Department of Neurosurgery, Graduate School of Medicine, Tohoku University, 1-1 Seiryo-cho, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Masayuki Kanamori
- Department of Neurosurgery, Graduate School of Medicine, Tohoku University, 1-1 Seiryo-cho, Aoba-ku, Sendai, Miyagi, 980-8574, Japan.
| | - Ryuta Saito
- Department of Neurosurgery, Graduate School of Medicine, Tohoku University, 1-1 Seiryo-cho, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Yuko Watanabe
- Department of Pediatrics, Graduate School of Medicine, Tohoku University, Sendai, Miyagi, Japan
| | - Hiroyoshi Suzuki
- Department of Pathology and Laboratory Medicine, National Hospital Organization Sendai Medical Center, Sendai, Japan
| | - Mika Watanabe
- Department of Pathology, Tohoku University Hospital, Sendai, Miyagi, Japan
| | - Shigeo Kure
- Department of Pediatrics, Graduate School of Medicine, Tohoku University, Sendai, Miyagi, Japan
| | - Teiji Tominaga
- Department of Neurosurgery, Graduate School of Medicine, Tohoku University, 1-1 Seiryo-cho, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
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Hasan S, Gigliotti MJ, Deutsch M, Reed SL, Wegner RE. A 58-Year-Old Woman with Left-Sided Weakness and a History of a Pediatric Brain Tumor: A Case Report. Case Rep Oncol 2018; 11:131-137. [PMID: 29681812 PMCID: PMC5903131 DOI: 10.1159/000487430] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 02/05/2018] [Indexed: 01/08/2023] Open
Abstract
Background An uncommon but well-established complication of cranial irradiation is secondary neoplasm. This case presentation documents a radiation-induced malignant glioma 55 years after being diagnosed with “cerebral sarcoma,” now defined as atypical meningioma. This not only represents the longest reported latency period for a patient initially receiving over 30 Gy, but also provides a valuable historical perspective of neuro-oncology. Clinical Presentation A 58-year-old female presenting with progressive left-sided upper and lower extremity weakness with a past medical history significant for “cerebral sarcoma” was diagnosed with glioblastoma multiforme. This patient had previously been treated with resection and adjuvant radiation therapy via a 280-kVP orthovoltage machine and received 3,390 rad to the posterior three-quarters of the skull for “cerebral sarcoma.” Conclusion A comprehensive investigation of the past medical history helped uncover a mysterious pediatric diagnosis, helped drive the management 5 decades later, and serves as a reminder that seemingly safe interventions may still cause harm.
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Affiliation(s)
- Shaakir Hasan
- Division of Radiation Oncology, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
| | - Michael J Gigliotti
- Division of Radiation Oncology, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
| | - Melvin Deutsch
- Department of Radiation Oncology, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Stacey L Reed
- Department of Pathology, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
| | - Rodney E Wegner
- Division of Radiation Oncology, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
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Yamanaka R, Hayano A, Kanayama T. Radiation-induced gliomas: a comprehensive review and meta-analysis. Neurosurg Rev 2016; 41:719-731. [DOI: 10.1007/s10143-016-0786-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 08/25/2016] [Accepted: 09/19/2016] [Indexed: 10/20/2022]
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Yamanaka R, Hayano A. Secondary glioma following acute lymphocytic leukemia: therapeutic implications. Neurosurg Rev 2016; 40:549-557. [DOI: 10.1007/s10143-016-0733-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 02/16/2016] [Accepted: 03/13/2016] [Indexed: 10/21/2022]
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Elsamadicy AA, Babu R, Kirkpatrick JP, Adamson DC. Radiation-Induced Malignant Gliomas: A Current Review. World Neurosurg 2015; 83:530-42. [DOI: 10.1016/j.wneu.2014.12.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Revised: 09/30/2014] [Accepted: 12/09/2014] [Indexed: 01/07/2023]
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Secondary glioblastoma multiforme in a child with disseminated juvenile pilocytic astrocytoma. Case Rep Oncol Med 2012; 2012:290905. [PMID: 23227384 PMCID: PMC3512259 DOI: 10.1155/2012/290905] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2012] [Accepted: 10/24/2012] [Indexed: 11/17/2022] Open
Abstract
Secondary glioblastoma multiforme (sGBM) can occur after a long latency period following radiation treatment of various diseases including brain tumors, leukemia, and more benign disorders like tinea capitis. Outcomes of radiation-induced sGBM remain poor in both children and adults. We report a case of a 16-year-old girl with a history of disseminated juvenile pilocytic astrocytoma treated with chemotherapy and craniospinal radiation 9 years prior who developed sGBM in the absence of a tumor predisposition syndrome. She presented with a several-week history of headaches and no acute findings on computed tomography compared to baseline neuroimaging 3 months prior. Repeat computed tomography performed just 3 weeks later for worsening headaches revealed a new large posterior fossa tumor where pathology confirmed the diagnosis of sGBM. In spite of maximal surgical resection, reirradiation, and adjuvant chemotherapy, she died 1 year postdiagnosis. Our case highlights the potential late effects of high-dose cranial radiation, how symptomatology may precede neuroimaging findings, and the rapid formation of sGBM that mirrors that of de novo Glioblastoma Multiforme.
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