Brain sarcoma of meningeal origin after cranial irradiation in childhood acute lymphocytic leukemia

Abstract

The authors report their experience with an unusual case of intracerebral sarcoma of meningeal cell origin in an 8 1/2-year-old girl. This tumor occurred 6 1/2 years after cranial irradiation at relatively low dosage (2200 rads) had been delivered to the head in the course of a multimodality treatment for acute lymphocytic leukemia. The tumor recurred approximately 10 months after the first surgical intervention. Macroscopic total excision of the recurrent growth followed by whole-brain irradiation (4500 rads) failed to eradicate it completely and local recurrence prompted reoperation 18 months later. This complication of treatment in long-term childhood leukemia survivors is briefly discussed, as well as the pathology of meningeal sarcomas.

Radiation oncogenesis in relation to the treatment of pituitary tumours

“…Radiation-induced sarcoma is a most serious complication, and its perceived rarity requires a search for collateral evidence which might help quantitate the risk. Immediately, we strike the difficulty that the vast majority of radiationassociated intracranial (non-pituitary) sarcomas have been in children (Tiberin et al, 1984;Kingston et al, 1987), especially in association with brain tumour and leukaemia; and as discussed later, in these there may be a predisposition to SND. This and the paucity of adult cases (which number fewer than the parasellar fibrosarcomas) prevent any useful deduction.…”

Second Malignant Neoplasms in Patients Treated for Childhood Leukemia: A Population‐based Cohort Study from the Nordic Countries

“…Cerebral reticulum cell sarcoma or "microglioma", a histologic diagnosis earlier often associated with brain tumors of short latency (28), has since been classified as cerebral lymphoma, two of which were registered in our study group. Of clearly different malignancies, various other intracerebral tumors have been reported after ALL; sarcomas, meningiomas and an increasing number of gliomas (29)(30)(31)(32)(33). In one study, nine anaplastic gliomas were registered among patients treated according to a protocol which included intrathecal methotrexate and cranial radiation with 24 Gy (16).…”

Radiation-induced gliosarcoma

“…That radiation-induced gliosarcoma appeared after acute lymphoblastic leukemia in our case may also imply secondary sarcomatous transformation, because all reported radiation-induced brain tumors appearing after acute lymphoblastic leukemia have been gliomas except for one meningeal sarcoma. 92 With regard to the three other radiation-induced gliosarcomas, the two cases described by Averback 6 only had a latency period of 1 year between irradiation and the diagnosis of the secondary tumor, a period that is somewhat short with regard to carcinogenesis. Moreover, his first case presented initially as a meningioma with incomplete removal of the tumor and postoperative radiation therapy; the secondary tumor was adherent to the dura, its superficial part was sarcomatous and its deeper part exhibited features of a glioblastoma.…”