ABSTRACT
Hemangiopericytomas are rare mesenchymal tumors with propensity to recur locally and metastasize. We report the unique case of a fifty-five-year-old male with recurrence of a previously resected craniocervical hemangiopericytoma presenting with obstructive hydrocephalus secondary to new metastatic cerebellar deposits. Emergent surgical resection of the cerebellar hemangiopericytomas was performed prior to adjuvant radiotherapy. Hemangiopericytomas are rare but important differentials for craniocervical junction lesions. Gross total resection remains the cornerstone of management with post-operative radiotherapy and chemotherapy as potential adjuncts. Tumors located in deep regions pose complex management challenges as safe maximal excision may be limited by proximal eloquent structures.
Subject(s)
Hemangiopericytoma/diagnostic imaging , Hydrocephalus/diagnostic imaging , Neoplasm Recurrence, Local/diagnostic imaging , Papilledema/diagnostic imaging , Skull Neoplasms/diagnostic imaging , Spinal Neoplasms/diagnostic imaging , Cervical Vertebrae/diagnostic imaging , Diagnosis, Differential , Hemangiopericytoma/complications , Hemangiopericytoma/radiotherapy , Humans , Hydrocephalus/complications , Hydrocephalus/radiotherapy , Male , Middle Aged , Neoplasm Recurrence, Local/complications , Neoplasm Recurrence, Local/radiotherapy , Papilledema/complications , Papilledema/radiotherapy , Radiosurgery/methods , Skull Neoplasms/complications , Skull Neoplasms/radiotherapy , Spinal Neoplasms/complications , Spinal Neoplasms/radiotherapyABSTRACT
CLINICAL CASE: A 39-year-old man with Philadelphia chromosome-positive acute lymphoblastic leukemia (LAL Ph+) developed progressive vision loss to no light perception in his right eye. He had optic disk edema and later developed central artery and vein occlusions. Pan-photocoagulation, as well as radiotherapy of the whole brain were performed in several fractions. Unfortunately the patient died of hematological relapse 4 months later. DISCUSSION: Optic nerve infiltration may appear as an isolated sign of a leukemia relapse, even before a hematological relapse occurs. Leukemic optic neuropathy is a critical sign, not only for vision, but also for life, and radiotherapy should be immediately performed before irreversible optic nerve damage occurs.
Subject(s)
Leukemic Infiltration/complications , Papilledema/etiology , Precursor Cell Lymphoblastic Leukemia-Lymphoma/complications , Retinal Artery Occlusion/etiology , Retinal Vein/pathology , Adult , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Combined Modality Therapy , Cord Blood Stem Cell Transplantation , Cranial Irradiation , Fatal Outcome , Humans , Leukemic Infiltration/diagnosis , Leukemic Infiltration/radiotherapy , Light Coagulation , Male , Papilledema/radiotherapy , Precursor Cell Lymphoblastic Leukemia-Lymphoma/pathology , Precursor Cell Lymphoblastic Leukemia-Lymphoma/therapy , RecurrenceABSTRACT
The current case report provides a comprehensive description of the persistent dysarthria and dysphagia evident in a 7.5 year old child treated for recurrent posterior fossa tumour (PFT). AC was assessed on a comprehensive perceptual and instrumental test battery incorporating all components of the speech production system (respiration, phonation, resonance, articulation and prosody) 2 years and 4 months following completion of her treatment. The nature of her swallowing impairment was investigated through the use of videofluoroscopic evaluation of swallowing (VFS). A mild dysarthria with ataxic and LMN components was identified, although overall speech intelligibility was not affected. A moderate dysphagia was also identified with impairment in all three phases of the swallowing process; oral preparatory, oral and pharyngeal. Dysarthria and dysphagia as persistent sequelae in children treated for PFT have implications for the long-term management of these children. The need for appropriate treatment regimes, as well as pre-surgical counselling regarding dysarthria and dysphagia as possible outcomes following surgery are highlighted.
Subject(s)
Astrocytoma/surgery , Deglutition Disorders/etiology , Dysarthria/etiology , Ependymoma/complications , Ependymoma/surgery , Infratentorial Neoplasms/surgery , Papilledema/surgery , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Astrocytoma/complications , Astrocytoma/drug therapy , Child, Preschool , Combined Modality Therapy , Ependymoma/therapy , Humans , Infratentorial Neoplasms/complications , Infratentorial Neoplasms/therapy , Neoplasms, Second Primary/complications , Neoplasms, Second Primary/surgery , Papilledema/drug therapy , Papilledema/radiotherapy , Postoperative ComplicationsSubject(s)
Meningioma/history , Adolescent , Brain Neoplasms/diagnosis , Brain Neoplasms/history , Child , Child, Preschool , Female , History, 20th Century , Humans , Infant , Male , Meningioma/diagnosis , Meningioma/epidemiology , Meningioma/etiology , Papilledema/history , Papilledema/radiotherapy , Radiotherapy/adverse effects , Radiotherapy/history , Tomography, X-Ray Computed/historyABSTRACT
A 40-year-old woman with acute lymphoblastic leukemia had a visual disturbance OD. The optic disc was slightly swollen in the right fundus, and blast cells in the cerebrospinal fluid were found. Radiotherapy to the brain and orbit resolved these findings. Five months later, visual acuity decreased OS. Radiotherapy also was effective in treating the leukemic involvement of the optic nerve.