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Radiation-induced meningeal osteosarcoma of tentorium cerebelli with intradural spinal metastases.

Ziewacz JE, Song JW, Blaivas M, Yang LJ - Surg Neurol Int (2010)

Bottom Line: Histopathologic analysis revealed chondroblastic osteosarcoma.The intracranial disease stabilized; however, multiple cervico-thoracic spinal metastases were discovered 15 months after initial diagnosis.The patient expired 16 months after initial diagnosis.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Neurosurgery, University of Michigan Health System, Ann Arbor, MI, USA.

ABSTRACT

Background: Primary meningeal osteosarcomas and radiation-induced extraosseous tumors are extremely rare. We encountered a patient with a radiation-induced meningeal osteosarcoma with metastatic spread.

Case description: A 54-year-old man presented with a 2-week history of nausea, vomiting, and ataxia. CT and MRI studies revealed an extra-axial, dural-based mass in the posterior fossa arising from the tentorium cerebelli. The patient underwent complete resection of the tumor with adjuvant chemotherapy. Histopathologic analysis revealed chondroblastic osteosarcoma. Tumor recurrence was observed 9 months after initial diagnosis, and adjuvant radiation therapy was administered. The intracranial disease stabilized; however, multiple cervico-thoracic spinal metastases were discovered 15 months after initial diagnosis. The patient expired 16 months after initial diagnosis.

Conclusion: Meningeal osteosarcomas are rare lesions that can metastasize and should be considered in the differential diagnosis for dural-based lesions, especially in the case of previous radiation therapy.

No MeSH data available.


Related in: MedlinePlus

Axial (left), sagittal (center), and coronal (right) T1-weighted MRIs with gadolinium enhancement illustrating suboccipital mass at patient's initial presentation
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Figure 0001: Axial (left), sagittal (center), and coronal (right) T1-weighted MRIs with gadolinium enhancement illustrating suboccipital mass at patient's initial presentation

Mentions: A 54-year-old man with a remote history of stage III Hodgkin's lymphoma treated 24 years earlier by mantle irradiation presented to our institution with a 2-week history of nausea, vomiting, and ataxia. On examination, he exhibited mild dysmetria and difficulty with rapid alternating movements in the left upper extremity, and a mildly wide-based gait. Brain magnetic resonance imaging (MRI) revealed a 3.6 cm × 3.4 cm × 3.2 cm homogenously enhancing extra-axial mass arising from the tentorium cerebelli, eccentric to the left and crossing the midline [Figure 1]. Bony involvement was not evident. There was surrounding edema and mild mass-effect on the fourth ventricle, but no evidence of obstructive hydrocephalus. The presumptive preoperative diagnosis was meningioma, given the homogenous enhancement, extra-axial location, and association with the tentorium. Computed tomography (CT) of the chest, abdomen, and pelvis revealed no evidence of metastatic disease.


Radiation-induced meningeal osteosarcoma of tentorium cerebelli with intradural spinal metastases.

Ziewacz JE, Song JW, Blaivas M, Yang LJ - Surg Neurol Int (2010)

Axial (left), sagittal (center), and coronal (right) T1-weighted MRIs with gadolinium enhancement illustrating suboccipital mass at patient's initial presentation
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2908355&req=5

Figure 0001: Axial (left), sagittal (center), and coronal (right) T1-weighted MRIs with gadolinium enhancement illustrating suboccipital mass at patient's initial presentation
Mentions: A 54-year-old man with a remote history of stage III Hodgkin's lymphoma treated 24 years earlier by mantle irradiation presented to our institution with a 2-week history of nausea, vomiting, and ataxia. On examination, he exhibited mild dysmetria and difficulty with rapid alternating movements in the left upper extremity, and a mildly wide-based gait. Brain magnetic resonance imaging (MRI) revealed a 3.6 cm × 3.4 cm × 3.2 cm homogenously enhancing extra-axial mass arising from the tentorium cerebelli, eccentric to the left and crossing the midline [Figure 1]. Bony involvement was not evident. There was surrounding edema and mild mass-effect on the fourth ventricle, but no evidence of obstructive hydrocephalus. The presumptive preoperative diagnosis was meningioma, given the homogenous enhancement, extra-axial location, and association with the tentorium. Computed tomography (CT) of the chest, abdomen, and pelvis revealed no evidence of metastatic disease.

Bottom Line: Histopathologic analysis revealed chondroblastic osteosarcoma.The intracranial disease stabilized; however, multiple cervico-thoracic spinal metastases were discovered 15 months after initial diagnosis.The patient expired 16 months after initial diagnosis.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Neurosurgery, University of Michigan Health System, Ann Arbor, MI, USA.

ABSTRACT

Background: Primary meningeal osteosarcomas and radiation-induced extraosseous tumors are extremely rare. We encountered a patient with a radiation-induced meningeal osteosarcoma with metastatic spread.

Case description: A 54-year-old man presented with a 2-week history of nausea, vomiting, and ataxia. CT and MRI studies revealed an extra-axial, dural-based mass in the posterior fossa arising from the tentorium cerebelli. The patient underwent complete resection of the tumor with adjuvant chemotherapy. Histopathologic analysis revealed chondroblastic osteosarcoma. Tumor recurrence was observed 9 months after initial diagnosis, and adjuvant radiation therapy was administered. The intracranial disease stabilized; however, multiple cervico-thoracic spinal metastases were discovered 15 months after initial diagnosis. The patient expired 16 months after initial diagnosis.

Conclusion: Meningeal osteosarcomas are rare lesions that can metastasize and should be considered in the differential diagnosis for dural-based lesions, especially in the case of previous radiation therapy.

No MeSH data available.


Related in: MedlinePlus