Abstract
Background:Radiation-induced glioma arising in the spinal cord is extremely rare. We report a case of radiation-induced spinal cord glioblastoma with cerebrospinal fluid (CSF) dissemination 10 years after radiotherapy for T-cell lymphoblastic lymphoma.Case Description:A 32-year-old male with a history of T-cell lymphoblastic lymphoma presented with progressive gait disturbance and sensory disturbance below the T4 dermatome 10 years after mediastinal irradiation. Gadolinium-enhanced magnetic resonance (MR) imaging revealed an intramedullary tumor extending from the C6 to the T6 level, corresponding to the previous radiation site, and periventricular enhanced lesions. In this case, the spinal lesion was not directly diagnosed because the patient refused any kind of spinal surgery to avoid worsening of neurological deficits. However, based on a biopsy of an intracranial disseminated lesion and repeated immmunocytochemical examination of CSF cytology, we diagnosed the spinal tumor as a radiation-induced glioblastoma. The patient was treated with radiotherapy plus concomitant and adjuvant temozolomide. Then, the spinal tumor was markedly reduced in size, and the dissemination disappeared.Conclusion:We describe our detailed diagnostic process and emphasize the diagnostic importance of immunocytochemical analysis of CSF cytology.
Highlights
Radiation‐induced glioma arising in the spinal cord is extremely rare
We report here a patient who developed a radiation‐induced spinal glioblastoma with cerebrospinal fluid (CSF) dissemination
The present case does not strictly meet the criteria of radiation‐induced glioblastoma because the histopathological diagnosis of the spinal lesion could not be confirmed. Because this patient had already presented with a severe transverse myelopathy and did not want spinal surgery including a biopsy to avoid worsening of the neurological deficits, we could not obtain a biopsy sample from his spinal cord
Summary
Radiation‐induced glioma arising in the spinal cord is extremely rare, with only seven cases previously reported.[3,6,9,14,15,20,25] We report here a patient who developed a radiation‐induced spinal glioblastoma with cerebrospinal fluid (CSF) dissemination. We obtained a sample of the periventricular lesion along the right anterior horn with a stereotactic biopsy through the right frontal lobe without ventricular puncture Histopathological examination of this sample showed diffuse proliferation of anaplastic glioma cells with hyperchromatic nuclei on a fibrillary background, along with a tendency for perivascular accumulation [Figure 3d]. The patient was treated with radiotherapy plus concomitant and adjuvant temozolomide He received 30 Gy whole‐brain radiation and boost 30 Gy radiation to the periventricular lesion in 40 fractions, as well as 30 Gy whole‐spine radiation and boost 22.5 Gy local radiation to the cervicothoracic spinal cord in 35 fractions.
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