Radiation-induced meningiomas in multiple regions, showing rapid recurrence and a high MIB 1 labeling index: a case report and review of the literature.

Yoshiaki Goto,Shoko M Yamada,Kazuto Yamazaki,Yasuo Ishida,Katsumi Hoya,Hiroshi Nakaguchi,So Yamada,Mineko Murakami,Akira Matsuno

doi:10.1186/1477-7819-12-123

Yoshiaki Goto, Shoko M Yamada + Show 7 more

Open Access

https://doi.org/10.1186/1477-7819-12-123

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Abstract

Combined chemotherapy and prophylactic cranial irradiation has improved the prognosis of children with acute leukemia. However cranial irradiation carries a latent risk of the induction of secondary intracranial tumors. We encountered a patient who developed multiple intracranial radiation-induced meningiomas (RIMs) 25 years after prophylactic cranial irradiation for the treatment of acute leukemia in childhood. The patient had 3 intracranial lesions, 1 of which showed rapid growth within 6 months; another of the tumors also enlarged within a short period. All of the tumors were surgically treated, and immunohistochemistry indicated a high MIB-1 labeling index in each of the multiple lesions. In the literature, the MIB-1 labeling indices of 27 tumors from 21 patients were examined. Among them, 12 recurrent tumors showed higher MIB-1 labeling indices compared to the MIB-1 labeling indices of the non-recurrent tumors. Overall, 11 of the patients with RIM had multiple lesions and 8 cases developed recurrence (72.7%). RIM cases with multiple lesions had higher MIB-1 labeling indices compared to the MIB-1 labeling indices of cases with single lesions. Collectively, these data showed that the MIB-1 labeling index is as important for predicting RIM recurrences, as it is for predicting sporadic meningioma (SM) recurrences. RIMs should be treated more aggressively than SMs because of their greater malignant potential.

Highlights

Children with acute leukemia have been treated with the combination of chemotherapy and prophylactic cranial irradiation
We report a patient who developed multiple intracranial meningiomas, all of which had aggressive clinical features and high MIB-1 labeling indices, 25 years after prophylactic cranial irradiation to treat acute leukemia in childhood
We experienced a case of multiple radiation-induced meningioma (RIM) with rapid tumor progression and recurrence within a short period, and the MIB-1 labeling indices in all tumors exceeded 10%

Summary

Background

Children with acute leukemia have been treated with the combination of chemotherapy and prophylactic cranial irradiation. We report a patient who developed multiple intracranial meningiomas, all of which had aggressive clinical features and high MIB-1 labeling indices, 25 years after prophylactic cranial irradiation to treat acute leukemia in childhood. Computed tomography (CT) of the brain showed no traumatic findings but incidentally revealed a small lesion in the left frontal convexity (Figure 1) Six months later, she suffered from headache, nausea, and vomiting. The two lesions on the right side were resected Histopathological examination identified both tumors as meningothelial meningioma with MIB-1 labeling indices of approximately 10% and 15%, respectively.

Discussion

Findings

19.5 Gy to basal skull 24 Gy to basal skull HD Gy to tumor

Conclusion