Limits...
Stereotactic aspiration combined with gamma knife radiosurgery for the treatment of cystic brainstem metastasis originating from lung adenosquamous carcinoma: A case report.

DU C, Li Z, Wang Z, Wang L, Tian YU - Oncol Lett (2015)

Bottom Line: Histology confirmed the diagnosis of adenosquamous carcinoma.The patient survived for 12 months following the repeat GKRS; however, later succumbed to the disease after lapsing into a two-week coma.The findings of this case suggest that stereotactic aspiration of cysts may improve the effects of GKRS for the treatment of cystic brainstem metastasis; the decrease in tumor volume allowed a higher radiation dose to be administered with a lower risk of radiation-induced side effects.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, China-Japan Union Hospital of Jilin University, Changchun, Jilin 130033, P.R. China.

ABSTRACT

Brainstem metastases have a poor prognosis and are difficult to manage. The present study describes the first case of histopathologically-confirmed brainstem metastasis originating from lung adenosquamous carcinoma, and discusses the outcomes of treatment by stereotactic aspiration combined with gamma knife radiosurgery (GKRS). A 59-year-old female presented with a cystic mass (15×12×13 mm; volume, 1.3 cm(3)) located in the pons, two years following surgical treatment for adenosquamous carcinoma of the lung. The patient received initial GKRS for the lesion in the pons with a total dose of 54.0 Gy, however, the volume of the mass subsequently increased to 3.9 cm(3) over a period of three months. Computed tomography-guided stereotactic biopsy and aspiration of the intratumoral cyst were performed, yielding 2.0 cm(3) of yellow-white fluid. Histology confirmed the diagnosis of adenosquamous carcinoma. Aspiration provided immediate symptomatic relief, and was followed one week later by repeat GKRS with a dose of 12.0 Gy. The patient survived for 12 months following the repeat GKRS; however, later succumbed to the disease after lapsing into a two-week coma. The findings of this case suggest that stereotactic aspiration of cysts may improve the effects of GKRS for the treatment of cystic brainstem metastasis; the decrease in tumor volume allowed a higher radiation dose to be administered with a lower risk of radiation-induced side effects. Therefore, stereotactic aspiration combined with GKRS may be an effective treatment for brainstem metastasis originating from adenosquamous carcinoma.

No MeSH data available.


Related in: MedlinePlus

Magnetic resonance images obtained five months following stereotactic aspiration. The tumor size was 12×13×14 mm (volume, 1.2 cm3). New metastases are visible in the cerebellum. (A) Axial T1-weighted, fluid-attenuated inversion recovery image and (B) sagittal T2-weighted image.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4356421&req=5

f7-ol-09-04-1607: Magnetic resonance images obtained five months following stereotactic aspiration. The tumor size was 12×13×14 mm (volume, 1.2 cm3). New metastases are visible in the cerebellum. (A) Axial T1-weighted, fluid-attenuated inversion recovery image and (B) sagittal T2-weighted image.

Mentions: Upon admission, magnetic resonance spectroscopy (MRS) with peritumoral measurements revealed that the choline/N-acetylaspartate (Cho/NAA) ratio was 3.09 (Fig. 3). Computed tomography-guided stereotactic biopsy and aspiration of the intratumoral cyst, performed three months following the initial GKRS, yielded 2.0 cm3 of yellow-white fluid (Fig. 4), and a smear of the hydatid fluid showed atypical cells (Fig. 5). Histopathology revealed the biopsy specimen to be a metastatic adenosquamous carcinoma originating from the lung. The sample exhibited similar hematoxylin and eosin morphology to lung adenosquamous carcinoma with predominant well-differentiated adenocarcinoma associated with heterologous elements of squamous cell carcinoma. An MRI scan for gamma knife radiosurgery planning conducted following stereotactic aspiration showed that the cystic tumor in the pons had decreased in size to 18×15×14 mm (volume, 1.9 cm3; Figure 6). The patient’s vertigo and gait instability improved within three days following the aspiration, and a second GKRS was performed one week later (dose, 12.0 Gy). Following discharge from hospital, the patient was alert and the neurological symptoms had resolved. A further MRI scan was performed five months subsequent to the repeat GKRS, revealing that the brainstem metastasis had reduced to 12×13×14 mm (volume, 1.2 cm3), without severe radiation-induced edema (Fig. 7). MRI also indicated that the brainstem metastasis was well controlled. The patient survived for 12 months following the repeat GKRS, however, later succumbed to the disease after lapsing into a two-week coma following the development and progression of new brain metastases.


Stereotactic aspiration combined with gamma knife radiosurgery for the treatment of cystic brainstem metastasis originating from lung adenosquamous carcinoma: A case report.

DU C, Li Z, Wang Z, Wang L, Tian YU - Oncol Lett (2015)

Magnetic resonance images obtained five months following stereotactic aspiration. The tumor size was 12×13×14 mm (volume, 1.2 cm3). New metastases are visible in the cerebellum. (A) Axial T1-weighted, fluid-attenuated inversion recovery image and (B) sagittal T2-weighted image.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4356421&req=5

f7-ol-09-04-1607: Magnetic resonance images obtained five months following stereotactic aspiration. The tumor size was 12×13×14 mm (volume, 1.2 cm3). New metastases are visible in the cerebellum. (A) Axial T1-weighted, fluid-attenuated inversion recovery image and (B) sagittal T2-weighted image.
Mentions: Upon admission, magnetic resonance spectroscopy (MRS) with peritumoral measurements revealed that the choline/N-acetylaspartate (Cho/NAA) ratio was 3.09 (Fig. 3). Computed tomography-guided stereotactic biopsy and aspiration of the intratumoral cyst, performed three months following the initial GKRS, yielded 2.0 cm3 of yellow-white fluid (Fig. 4), and a smear of the hydatid fluid showed atypical cells (Fig. 5). Histopathology revealed the biopsy specimen to be a metastatic adenosquamous carcinoma originating from the lung. The sample exhibited similar hematoxylin and eosin morphology to lung adenosquamous carcinoma with predominant well-differentiated adenocarcinoma associated with heterologous elements of squamous cell carcinoma. An MRI scan for gamma knife radiosurgery planning conducted following stereotactic aspiration showed that the cystic tumor in the pons had decreased in size to 18×15×14 mm (volume, 1.9 cm3; Figure 6). The patient’s vertigo and gait instability improved within three days following the aspiration, and a second GKRS was performed one week later (dose, 12.0 Gy). Following discharge from hospital, the patient was alert and the neurological symptoms had resolved. A further MRI scan was performed five months subsequent to the repeat GKRS, revealing that the brainstem metastasis had reduced to 12×13×14 mm (volume, 1.2 cm3), without severe radiation-induced edema (Fig. 7). MRI also indicated that the brainstem metastasis was well controlled. The patient survived for 12 months following the repeat GKRS, however, later succumbed to the disease after lapsing into a two-week coma following the development and progression of new brain metastases.

Bottom Line: Histology confirmed the diagnosis of adenosquamous carcinoma.The patient survived for 12 months following the repeat GKRS; however, later succumbed to the disease after lapsing into a two-week coma.The findings of this case suggest that stereotactic aspiration of cysts may improve the effects of GKRS for the treatment of cystic brainstem metastasis; the decrease in tumor volume allowed a higher radiation dose to be administered with a lower risk of radiation-induced side effects.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, China-Japan Union Hospital of Jilin University, Changchun, Jilin 130033, P.R. China.

ABSTRACT

Brainstem metastases have a poor prognosis and are difficult to manage. The present study describes the first case of histopathologically-confirmed brainstem metastasis originating from lung adenosquamous carcinoma, and discusses the outcomes of treatment by stereotactic aspiration combined with gamma knife radiosurgery (GKRS). A 59-year-old female presented with a cystic mass (15×12×13 mm; volume, 1.3 cm(3)) located in the pons, two years following surgical treatment for adenosquamous carcinoma of the lung. The patient received initial GKRS for the lesion in the pons with a total dose of 54.0 Gy, however, the volume of the mass subsequently increased to 3.9 cm(3) over a period of three months. Computed tomography-guided stereotactic biopsy and aspiration of the intratumoral cyst were performed, yielding 2.0 cm(3) of yellow-white fluid. Histology confirmed the diagnosis of adenosquamous carcinoma. Aspiration provided immediate symptomatic relief, and was followed one week later by repeat GKRS with a dose of 12.0 Gy. The patient survived for 12 months following the repeat GKRS; however, later succumbed to the disease after lapsing into a two-week coma. The findings of this case suggest that stereotactic aspiration of cysts may improve the effects of GKRS for the treatment of cystic brainstem metastasis; the decrease in tumor volume allowed a higher radiation dose to be administered with a lower risk of radiation-induced side effects. Therefore, stereotactic aspiration combined with GKRS may be an effective treatment for brainstem metastasis originating from adenosquamous carcinoma.

No MeSH data available.


Related in: MedlinePlus