Glioblastoma following radiosurgery for meningioma

Abstract

We report a patient who underwent gamma knife radiosurgery to treat recurrent meningioma after microsurgery and thereafter developed secondary malignancy adjacent to the original tumor. A 47-year-old woman had underwent resection of the olfactory groove meningioma. Then radiosurgery was done three times over 4 year period for the recurrent tumor. After 58 months from the initial radiosurgery, she presented with headache and progressive mental dullness. Huge tumor in bifrontal location was revealed in MRI. Subsequent operation and pathological examination confirmed diagnosis of glioblastoma. This case fits the criteria of radiation-induced tumor and the clinical implication of the issue is discussed.

Keywords: Glioblastoma; Radiosurgery.

Fig. 1

T1-weighted contrast enhanced magnetic resonance image showing well enhanced frontal meningioma upon the olfactory groove.

Fig. 2

First Gamma Knife Surgery planning for meningioma which maximum radiating doses were 30 Gy on July 2004 (A) and 25 Gy on May 2007 (B) and 28 Gy on May 2009 (C).

Fig. 3

T1-weighted contrast enhanced magnetic resonance image demonstrating a mass with peripheral enhancement and central necrosis involving both frontal lobes with extension into the corpus callosum after 58 months from diagnosis of GM.

Fig. 4

Photomicrographs of the lesion demonstrate an infiltrating glial neoplasm comprised of highly atypical cells with pleomorphic angular nuclei and modest eosinophilic cytoplasm consistent with astrocytic lineage. Numerous mitoses and tumoral necrosis are present. This presentation is compatible with a glioblastoma.