Komatsu Fuminari, Kawaguchi Hiroshi, Tsugu Hitoshi, Oshiro Shinya, Komatsu Mika, Fukushima Takeo, Nabeshima Kazuki, Inoue Tooru
Department of Neurosurgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan.
Neurol Med Chir (Tokyo). 2011;51(3):243-6. doi: 10.2176/nmc.51.243.
A 23-year-old man was admitted with a rare case of radiation-induced astrocytoma manifesting as 3-month history of unstable gait. He had received 50 Gy of irradiation therapy for a germ cell tumor in the right basal ganglia 13 years earlier. Magnetic resonance (MR) imaging on admission showed a non-enhanced mass lesion in the right cerebellar hemisphere with expansion to the vermis. The histological diagnosis of the stereotaxic biopsy specimen was grade II astrocytoma. Two months later, he developed drowsiness, and MR imaging demonstrated that the tumor had enlarged and was enhanced after gadolinium injection. The clinical diagnosis was high-grade glioma resulting from malignant transformation. The tumor had compressed the mesencephalic aqueduct, leading to obstructive hydrocephalus. Endoscopic third ventriculostomy was performed to improve the cerebrospinal fluid circulation. He underwent chemotherapy with temozolomide postoperatively, but died 8 months after the initial diagnosis of astrocytoma. The clinical course of radiation-induced astrocytoma is not benign. The potential for malignant transformation necessitates careful postoperative follow up for patients with this tumor.
一名23岁男性因罕见的放射性星形细胞瘤入院，其表现为3个月的步态不稳病史。13年前，他因右侧基底节区生殖细胞瘤接受了50 Gy的放射治疗。入院时的磁共振成像显示右侧小脑半球有一个无强化的肿块病变，并延伸至蚓部。立体定向活检标本的组织学诊断为II级星形细胞瘤。两个月后，他出现嗜睡，磁共振成像显示肿瘤增大，注射钆后有强化。临床诊断为恶性转化导致的高级别胶质瘤。肿瘤压迫中脑导水管，导致梗阻性脑积水。进行了内镜下第三脑室造瘘术以改善脑脊液循环。术后他接受了替莫唑胺化疗，但在星形细胞瘤初步诊断后8个月死亡。放射性星形细胞瘤的临床病程并非良性。恶性转化的可能性使得对此类肿瘤患者术后需要进行仔细的随访。
