Wagner C, Alfattal R, Mallick J
Department of Pathology and Laboratory Medicine, University of Texas Medical Branch, Galveston, TX, USA.
Department of Molecular Genetic Pathology, MD Anderson Cancer Center, Houston, TX, USA.
Int J Surg Pathol. 2024 Oct 7;33(4):10668969241286061. doi: 10.1177/10668969241286061.
The significance of radiation therapy in cancer treatment comes with associated complications, including fibrosis, osteonecrosis, and the development of secondary malignancies, such as malignant peripheral nerve sheath tumors (MPNSTs). We emphasize the importance of understanding these complications for an effective patient management.
We report a 47-year-old man with a history of squamous cell carcinoma of the tongue, treated with surgery, chemotherapy, and radiation therapy. The patient later presented with symptoms that led to the discovery of an intraosseous MPNST.
Histopathological examination revealed characteristic features of MPNST, including spindle cells arranged is sweeping fascicles with contrasting hypercellular and hypocellular areas, producing a marble-like pattern, with atypical wavy, buckled, hyperchromatic nuclei, and brisk mitotic activity. Immunohistochemical analysis showed patchy positive staining for S100 and SOX10, and a complete loss of H3K27me3 expression. This report underscores the challenge of diagnosing secondary malignancies post-radiation therapy and the importance of careful histological examination to differentiate them from other conditions.
In conclusion, radiation-induced secondary malignancies are a significant late side effect of radiation therapy that can profoundly impact treatment decision-making and requires a high index of suspicion during post radiation surveillance. Malignant peripheral nerve sheath tumor serves as a pertinent example, highlighting the importance of considering long-term risks when developing optimal management plans for cancer patients.
放射治疗在癌症治疗中的重要性伴随着相关并发症，包括纤维化、骨坏死以及继发性恶性肿瘤的发生，如恶性外周神经鞘瘤（MPNST）。我们强调了解这些并发症对于有效管理患者的重要性。
我们报告了一名47岁男性，有舌鳞状细胞癌病史，接受了手术、化疗和放射治疗。该患者后来出现的症状导致发现了一例骨内MPNST。
组织病理学检查显示MPNST的特征性表现，包括梭形细胞呈束状排列，有细胞丰富区和细胞稀少区形成对比，产生大理石样图案，细胞核呈非典型波浪状、扭曲、深染，有活跃的有丝分裂活性。免疫组织化学分析显示S100和SOX10呈斑片状阳性染色，H3K27me3表达完全缺失。本报告强调了放射治疗后诊断继发性恶性肿瘤的挑战以及仔细的组织学检查以将其与其他情况区分开来的重要性。
总之，放射诱导的继发性恶性肿瘤是放射治疗的一种重要晚期副作用，可深刻影响治疗决策，在放射治疗后的监测期间需要高度怀疑。恶性外周神经鞘瘤就是一个相关例子，突出了在为癌症患者制定最佳管理计划时考虑长期风险的重要性。
