ABSTRACT
BACKGROUND: The majority of patients with acute lymphoblastic leukaemia develop disease relapse in the central nervous system in the absence of central nervous system-directed prophylactic therapy. In the past, prophylactic cranial irradiation was commonly used in the form of whole-brain radiotherapy in patients with acute lymphoblastic leukemia to prevent the development of intracranial diseases. However, in addition to the inherent risk of toxicity, this type of therapy has several delayed side effects including the development of secondary intracranial tumors. CASE DESCRIPTION: We report a rare case of a patient with concurrent pituicytoma, meningioma, and cavernomas 44 years after prophylactic cranial irradiation for childhood acute lymphoblastic leukemia. The patient presented with visual disturbance, headache, and features of hypopituitarism. Endoscopic transsphenoidal resection of the pituicytoma and meningioma was performed. Subsequent regrowth of the residual meningioma necessitated further surgery and adjuvant treatment with radiotherapy. CONCLUSIONS: This case report highlights the unusual case of a patient with 3 concurrent intracranial lesions of distinct pathologies after prophylactic cranial irradiation therapy for childhood acute lymphoblastic leukemia.
Subject(s)
Meningeal Neoplasms/etiology , Meningioma/etiology , Neoplasms, Radiation-Induced/etiology , Pituitary Neoplasms/etiology , Precursor Cell Lymphoblastic Leukemia-Lymphoma/radiotherapy , Adult , Female , HumansABSTRACT
We report a case of a 40â¯year old female who presented with a three month history of headaches with a background of Myasthenia Gravis (MG), treated with azathioprine. MRI brain demonstrated a rim-enhancing lesion in the left posterior fossa. CT scan of the chest abdomen and pelvis revealed no other lesion. The patient was taken for resection of the lesion via left retrosigmoid approach. Histologically the neoplasm was a large B-cell lymphoma, Epstein-Barr virus (EBV) positive, with clonality confirmed by IGH gene rearrangement studies. To the best of our knowledge this is the first case of primary central nervous system (CNS) EBV-positive diffuse large B-cell lymphoma of the posterior fossa in a patient with MG treated with azathioprine.
