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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

Histology section of resected tumor reveals malignant osteoid formation (hematoxylin and eosin staining; ×200 magnification)
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Figure 0003: Histology section of resected tumor reveals malignant osteoid formation (hematoxylin and eosin staining; ×200 magnification)

Mentions: Histopathologic analysis of the mass revealed a chondroblastic osteosarcoma with highly malignant features, including bizarre neoplastic cells, abnormal mitotic figures, and a MIB-1 index of 90%. Formalin-fixed paraffin-embedded sections of the tumor were stained with hematoxylin and eosin (HandE), trichrome, as well as several immunohistochemical markers. The mitotically active neoplasm was composed of pleomorphic cells with hyperchromatic multinucleated forms and focal osteoid formation [Figure 3]. Neoplastic cells were positive for vimentin, but negative for epithelial membrane antigen, thereby excluding the diagnosis of a meningioma. Staining for CD68 was also negative. Regions of cartilage formation were positive for S-100 protein. Infiltration of adjacent brain parenchyma by neoplastic cells was apparent in sections stained for neurofilament protein and synaptophysin. These features were thought to be consistent with a radiation-induced chondroblastic osteosarcoma.


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

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

Histology section of resected tumor reveals malignant osteoid formation (hematoxylin and eosin staining; ×200 magnification)
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 0003: Histology section of resected tumor reveals malignant osteoid formation (hematoxylin and eosin staining; ×200 magnification)
Mentions: Histopathologic analysis of the mass revealed a chondroblastic osteosarcoma with highly malignant features, including bizarre neoplastic cells, abnormal mitotic figures, and a MIB-1 index of 90%. Formalin-fixed paraffin-embedded sections of the tumor were stained with hematoxylin and eosin (HandE), trichrome, as well as several immunohistochemical markers. The mitotically active neoplasm was composed of pleomorphic cells with hyperchromatic multinucleated forms and focal osteoid formation [Figure 3]. Neoplastic cells were positive for vimentin, but negative for epithelial membrane antigen, thereby excluding the diagnosis of a meningioma. Staining for CD68 was also negative. Regions of cartilage formation were positive for S-100 protein. Infiltration of adjacent brain parenchyma by neoplastic cells was apparent in sections stained for neurofilament protein and synaptophysin. These features were thought to be consistent with a radiation-induced chondroblastic osteosarcoma.

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