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[CNS primitive neuroectodermal tumor suspected as a secondary recurrence after radiation therapy for medulloblastoma:a case report].

Abstract

We report a case of a suspected secondary central nervous system(CNS)primitive neuroectodermal tumor(PNET)that developed 25 years after radiation therapy for a medulloblastoma of the cerebellum. At 5 years of age, the patient underwent craniotomy and subsequent radiation therapy of the whole brain(39Gy), whole spinal cord(9Gy), and posterior fossa(49Gy)for the treatment of a medulloblastoma of the cerebellum;the patient did not receive chemotherapy. After radiation therapy, the medulloblastoma completely receded and did not recur. Twenty-five years later, at 30 years of age, the patient visited our institution experiencing right-sided hemiparesis and aphasia that had arisen approximately 1 month prior and had gradually worsened. The patient was subsequently hospitalized after experiencing disturbed consciousness and a generalized convulsion seizure. Gadolinium-enhanced magnetic resonance imaging(MRI)revealed a mass accompanied by a large cyst in the left frontal lobe. Complete tumor resection was achieved via macroscopic surgery, and the histopathological findings were indicative of CNS PNET. Considering the tumor occurred in the same site where radiation therapy had been previously administered to treat a medulloblastoma, additional radiotherapy was avoided in favor of combination chemotherapy with ifosfamide, cisplatin, and etoposide. Tumor recurrence was not observed in a follow-up MRI after 6 courses of ICE therapy, and the patient has resumed a normal life. The present case, a CNS PNET, is suspected as a secondary brain tumor induced by radiation therapy previously used to treat a medulloblastoma, and it represents a rare late-onset complication of radiation therapy. For the treatment of PNET, we believe that maximal safe surgical resection of the tumor and post-operative radiation therapy are typically necessary for long-term survival. However, taking into account the risks of repeated exposure to radiation, we did not perform post-operative radiation therapy for this patient. We have not observed recurrence to date;however, the patient will require a strict follow-up schedule hereafter.

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  • Authors+Show Affiliations

    ,

    Department of Neurosurgery, Takeda General Hospital.

    , , ,

    Source

    MeSH

    Adult
    Antineoplastic Combined Chemotherapy Protocols
    Brain Neoplasms
    Chemoradiotherapy
    Cisplatin
    Humans
    Ifosfamide
    Magnetic Resonance Imaging
    Male
    Medulloblastoma
    Neoplasm Recurrence, Local
    Neuroectodermal Tumors, Primitive
    Treatment Outcome

    Pub Type(s)

    Case Reports
    English Abstract
    Journal Article
    Review

    Language

    jpn

    PubMed ID

    25006105

    Citation

    Sato, Hiroyuki, et al. "[CNS Primitive Neuroectodermal Tumor Suspected as a Secondary Recurrence After Radiation Therapy for Medulloblastoma:a Case Report]." No Shinkei Geka. Neurological Surgery, vol. 42, no. 7, 2014, pp. 641-50.
    Sato H, Shibuya K, Koizumi T, et al. [CNS primitive neuroectodermal tumor suspected as a secondary recurrence after radiation therapy for medulloblastoma:a case report]. No Shinkei Geka. 2014;42(7):641-50.
    Sato, H., Shibuya, K., Koizumi, T., Kato, S., & Endo, S. (2014). [CNS primitive neuroectodermal tumor suspected as a secondary recurrence after radiation therapy for medulloblastoma:a case report]. No Shinkei Geka. Neurological Surgery, 42(7), pp. 641-50.
    Sato H, et al. [CNS Primitive Neuroectodermal Tumor Suspected as a Secondary Recurrence After Radiation Therapy for Medulloblastoma:a Case Report]. No Shinkei Geka. 2014;42(7):641-50. PubMed PMID: 25006105.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - [CNS primitive neuroectodermal tumor suspected as a secondary recurrence after radiation therapy for medulloblastoma:a case report]. AU - Sato,Hiroyuki, AU - Shibuya,Kouhei, AU - Koizumi,Takayuki, AU - Kato,Shunichi, AU - Endo,Shin, PY - 2014/7/10/entrez PY - 2014/7/10/pubmed PY - 2014/10/1/medline SP - 641 EP - 50 JF - No shinkei geka. Neurological surgery JO - No Shinkei Geka VL - 42 IS - 7 N2 - We report a case of a suspected secondary central nervous system(CNS)primitive neuroectodermal tumor(PNET)that developed 25 years after radiation therapy for a medulloblastoma of the cerebellum. At 5 years of age, the patient underwent craniotomy and subsequent radiation therapy of the whole brain(39Gy), whole spinal cord(9Gy), and posterior fossa(49Gy)for the treatment of a medulloblastoma of the cerebellum;the patient did not receive chemotherapy. After radiation therapy, the medulloblastoma completely receded and did not recur. Twenty-five years later, at 30 years of age, the patient visited our institution experiencing right-sided hemiparesis and aphasia that had arisen approximately 1 month prior and had gradually worsened. The patient was subsequently hospitalized after experiencing disturbed consciousness and a generalized convulsion seizure. Gadolinium-enhanced magnetic resonance imaging(MRI)revealed a mass accompanied by a large cyst in the left frontal lobe. Complete tumor resection was achieved via macroscopic surgery, and the histopathological findings were indicative of CNS PNET. Considering the tumor occurred in the same site where radiation therapy had been previously administered to treat a medulloblastoma, additional radiotherapy was avoided in favor of combination chemotherapy with ifosfamide, cisplatin, and etoposide. Tumor recurrence was not observed in a follow-up MRI after 6 courses of ICE therapy, and the patient has resumed a normal life. The present case, a CNS PNET, is suspected as a secondary brain tumor induced by radiation therapy previously used to treat a medulloblastoma, and it represents a rare late-onset complication of radiation therapy. For the treatment of PNET, we believe that maximal safe surgical resection of the tumor and post-operative radiation therapy are typically necessary for long-term survival. However, taking into account the risks of repeated exposure to radiation, we did not perform post-operative radiation therapy for this patient. We have not observed recurrence to date;however, the patient will require a strict follow-up schedule hereafter. SN - 0301-2603 UR - https://www.unboundmedicine.com/medline/citation/25006105/[CNS_primitive_neuroectodermal_tumor_suspected_as_a_secondary_recurrence_after_radiation_therapy_for_medulloblastoma:a_case_report]_ L2 - https://webview.isho.jp/openurl?rft.genre=article&rft.issn=0301-2603&rft.volume=42&rft.issue=7&rft.spage=641 DB - PRIME DP - Unbound Medicine ER -