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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 T1-weighted MRI with gadolinium enhancement showing recurrence of lesion
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Figure 0004: Axial T1-weighted MRI with gadolinium enhancement showing recurrence of lesion

Mentions: On the basis of the pathology findings, the patient underwent two rounds of ifosfamide and doxorubicin chemotherapy. Radiation therapy was initially deferred due to both previous irradiation to the area and relative radioresistant nature of these tumors.[1215] Each round of chemotherapy was associated with intractable nausea and vomiting requiring hospitalization. The second hospitalization was complicated by a deep vein thrombosis requiring anticoagulation, organizing pneumonia with bronchiolitis obliterans, and methicillin-resistant Staphylococcus aureus bacteremia. The patient recovered from these hospitalizations, and he was at his neurologic baseline. Nine months after his initial presentation, routine MRI revealed local recurrence of the disease [Figure 4]. Radiation therapy was scheduled. However, when the patient presented for therapy, he was experiencing significant ataxia, nausea, and vomiting. A noncontrast head CT was performed, which showed the known recurrence as well as obstructive hydrocephalus. The patient and his family declined further resection but wished to proceed with palliative ventriculoperitoneal shunting. This procedure was performed without complications. After shunt placement, the patient underwent intensity-modulated radiation therapy with a total dose of 65 Gy to the tumor bed. The patient′s symptoms improved and follow-up imaging revealed a reduction in tumor size. He remained stable for 3 months after the completion of radiation therapy, but then experienced progressively worsening bilateral lower extremity weakness over the course of 3 days. MRI of the thoracolumbar spine performed as part of a work-up for his weakness revealed multiple intradural, intra-, and extramedullary masses, as well as diffuse epidural enhancement consistent with metastatic disease [Figure 5]. Palliative radiation was performed for symptom control. The patient was discharged to hospice where he succumbed to his disease 16 months after initial presentation.


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

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

Axial T1-weighted MRI with gadolinium enhancement showing recurrence of lesion
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 0004: Axial T1-weighted MRI with gadolinium enhancement showing recurrence of lesion
Mentions: On the basis of the pathology findings, the patient underwent two rounds of ifosfamide and doxorubicin chemotherapy. Radiation therapy was initially deferred due to both previous irradiation to the area and relative radioresistant nature of these tumors.[1215] Each round of chemotherapy was associated with intractable nausea and vomiting requiring hospitalization. The second hospitalization was complicated by a deep vein thrombosis requiring anticoagulation, organizing pneumonia with bronchiolitis obliterans, and methicillin-resistant Staphylococcus aureus bacteremia. The patient recovered from these hospitalizations, and he was at his neurologic baseline. Nine months after his initial presentation, routine MRI revealed local recurrence of the disease [Figure 4]. Radiation therapy was scheduled. However, when the patient presented for therapy, he was experiencing significant ataxia, nausea, and vomiting. A noncontrast head CT was performed, which showed the known recurrence as well as obstructive hydrocephalus. The patient and his family declined further resection but wished to proceed with palliative ventriculoperitoneal shunting. This procedure was performed without complications. After shunt placement, the patient underwent intensity-modulated radiation therapy with a total dose of 65 Gy to the tumor bed. The patient′s symptoms improved and follow-up imaging revealed a reduction in tumor size. He remained stable for 3 months after the completion of radiation therapy, but then experienced progressively worsening bilateral lower extremity weakness over the course of 3 days. MRI of the thoracolumbar spine performed as part of a work-up for his weakness revealed multiple intradural, intra-, and extramedullary masses, as well as diffuse epidural enhancement consistent with metastatic disease [Figure 5]. Palliative radiation was performed for symptom control. The patient was discharged to hospice where he succumbed to his disease 16 months after initial presentation.

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