Radiation-induced spinal cord glioblastoma with cerebrospinal fluid dissemination subsequent to treatment of lymphoblastic lymphoma

Recurrence of cervical intramedullary gliofibroma

INTRODUCTION

Gliofibroma is a rare tumor that develops in the brain and spinal cord. Due to the rarity of its nature, its pathophysiology and appropriate treatment remain elusive. We report a case of intramedullary spinal cord gliofibroma that was surgically treated multiple times. This report is of great significance because this is the first case of recurrence of this tumor.

CASE PRESENTATION

A 32-year-old woman complained of gait disturbance and was referred to our institution. At the age of 13 years, she was diagnosed with intramedullary gliofibroma and underwent gross total resection (GTR) in another hospital. Based on imaging findings, tumor recurrence was suspected at the level of cervical spinal cord, and surgery was performed. However, the resection volume was limited to 50% because the boundary between the tumor and spinal cord tissue was unclear and intraoperative neuromonitoring alerted paralysis. At 1 year postoperatively, the second surgery was performed to try to resect the residual tumor, but subtotal resection was achieved at most. At 2 years after the final surgery, no tumor recurrence was observed, and neurologic function was maintained to gait with cane.

DISCUSSION

Although complete resection is desirable for this rare tumor at the initial surgery, there is a possibility to recur even after GTR with long-term follow-up. During surgical treatment for tumor recurrence, fair adhesion to the spinal cord is expected, and reoperation and/or adjuvant therapy might be considered in the future if the tumor regrows and triggers neurological deterioration.

Radiation-induced spinal cord glioblastoma subsequent to treatment of medulloblastoma: case report

Medulloblastomas are one of the most common malignant pediatric brain tumors. Therapy has evolved into multimodality treatments consisting of surgery, radiation, and adjuvant chemotherapy. While craniospinal radiation remains standard for patients older than 3 years of age, it is not free of side effects and long-term complications. The development of malignant gliomas following therapy is a well-documented phenomenon. However, the majority of these radiation-induced glioblastomas (RIG) are intracranial, and intraspinal lesions are rare. The patient is a 22-year-old female with a history of a posterior fossa medulloblastoma diagnosed 8 years prior for which she underwent surgical resection followed by adjuvant chemotherapy and craniospinal radiation. Surveillance imaging showed no evidence of recurrence or new lesions for the following 5 years. She presented with nausea and vomiting and imaging revealing a new intramedullary cervical spinal cord lesion. She then developed acute quadriplegia several days after presentation. She underwent a cervical laminectomy and resection of this lesion, which was initially diagnosed as recurrent medulloblastoma before genomic analysis ultimately revealed it to be a RIG. Spinal RIGs that occur secondary to treatment for an intracranial neoplasm are exceedingly rare. The majority of spinal cord RIGs have been reported secondary to treatment for tumors outside of the neuroaxis, while the majority of RIGs secondary to treatment for intracranial tumors remain intracranial. Nevertheless, RIGs are associated with a short clinical history, aggressive progression, and poor outcome.

Radiation-induced glioblastoma of the conus medullaris from radiation treatment of cervical cancer

Radiation-induced spinal glioblastoma is an extremely rare disease with only four previously published reports in the literature. We report the fifth case, a 69-year-old woman who previously underwent treatment with brachytherapy for cervical cancer, and thereafter presented with neurologic deficits from a conus medullaris tumour. Biopsy and histopathology confirm glioblastoma, not otherwise specified. Treatment of spinal glioblastoma consists of surgery, either biopsy or excision and chemoradiation. However, results are still unsatisfactory and prognosis remains poor.