Radiation-induced spinal cord glioblastoma with cerebrospinal fluid dissemination subsequent to treatment of lymphoblastic lymphoma

Abstract

Background: Radiation-induced glioma arising in the spinal cord is extremely rare. We report a case of radiation-induced spinal cord glioblastoma with cerebrospinal fluid (CSF) dissemination 10 years after radiotherapy for T-cell lymphoblastic lymphoma.

Case description: A 32-year-old male with a history of T-cell lymphoblastic lymphoma presented with progressive gait disturbance and sensory disturbance below the T4 dermatome 10 years after mediastinal irradiation. Gadolinium-enhanced magnetic resonance (MR) imaging revealed an intramedullary tumor extending from the C6 to the T6 level, corresponding to the previous radiation site, and periventricular enhanced lesions. In this case, the spinal lesion was not directly diagnosed because the patient refused any kind of spinal surgery to avoid worsening of neurological deficits. However, based on a biopsy of an intracranial disseminated lesion and repeated immmunocytochemical examination of CSF cytology, we diagnosed the spinal tumor as a radiation-induced glioblastoma. The patient was treated with radiotherapy plus concomitant and adjuvant temozolomide. Then, the spinal tumor was markedly reduced in size, and the dissemination disappeared.

Conclusion: We describe our detailed diagnostic process and emphasize the diagnostic importance of immunocytochemical analysis of CSF cytology.

Keywords: Glioblastoma multiforme; nonHodgkin's lymphoma; radiotherapy; spinal cord.

Figure 1

Isodose curve showing the radiation coverage for the anterior mediastinal lymphadenopathy

Figure 2

(a-c) Gadolinium-enhanced T1-weighted MR images showing an irregularly enhanced intramedullary lesion at the C6-T6 spinal level with enhancement along the dorsal surface of the spinal cord (a) and intracranial enhanced lesions located along the ventricular surface (b, c)

Figure 3

(a) May-Giemsa staining of the CSF sediment showing atypical cells, (b, c) Immunocytochemistry of the CSF sediment showing atypical cells (white arrowheads) with enlarged hyperchromatic delicate irregular nuclei that are positive for Olig2, (b) and negative for LCA (c), The surrounding lymphocytes (black arrowheads) are positive for LCA, (c) and negative for Olig2 (b) (100 × objective), (d, e) Paraffin sections of the biopsy of the intracranial lesion. H and E staining, (d) and Olig2 immunostaining, (e) Scale bars = 50 μm

Figure 4

(a-c) Gadolinium-enhanced T1-weighted MR images showing marked reduction in the size of the enhanced lesion of the spinal cord (a) and the disappearance of the periventricular dissemination (b, c)