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Three case reports of radiation-induced glioblastoma after complete remission of acute lymphoblastic leukemia

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Abstract

Radiation therapy is sometimes performed to control intracranial acute lymphoblastic leukemia (ALL), but may lead to radiation-induced malignant glioma. The clinical, radiological, histological, and molecular findings are described of three cases of radiation-induced glioblastoma after the treatment for ALL. They received radiation therapy at age 6–8 years. The latency from radiation therapy to the onset of radiation-induced glioblastoma was 5–10 years. Magnetic resonance imaging demonstrated diffuse lesions with multiple small enhanced lesions in all cases. Histological examination showed that the tumors consisted of mainly small round astrocytic atypical cells in one case, and astrocytic atypical cells with elongated cytoplasm and nuclear pleomorphism with small cell component in two cases. Microvascular proliferation was present in all cases. Immunohistochemical analysis for B-Raf V600E, and mutational analysis for the isocitrate dehydrogenase (IDH) 1, IDH2, and H3F3A gene revealed the wild-type alleles in all three cases. The integrated diagnoses were IDH wild-type glioblastoma, and local irradiation and concomitant temozolomide were performed. After the initial treatment, significant shrinkage of the diffuse lesion and enhanced lesion was found in all cases. Radiation-induced glioblastoma occurring after the treatment for ALL had unique clinical, radiological, histological, and molecular characteristics in our three cases.

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Authors and Affiliations

  1. Department of Neurosurgery, Graduate School of Medicine, Tohoku University, 1-1 Seiryo-cho, Aoba-ku, Sendai, Miyagi, 980-8574, Japan

    Takumi Kajitani, Masayuki Kanamori, Ryuta Saito & Teiji Tominaga

  2. Department of Pediatrics, Graduate School of Medicine, Tohoku University, Sendai, Miyagi, Japan

    Yuko Watanabe & Shigeo Kure

  3. Department of Pathology and Laboratory Medicine, National Hospital Organization Sendai Medical Center, Sendai, Japan

    Hiroyoshi Suzuki

  4. Department of Pathology, Tohoku University Hospital, Sendai, Miyagi, Japan

    Mika Watanabe

Authors
  1. Takumi Kajitani
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  2. Masayuki Kanamori
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  3. Ryuta Saito
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  4. Yuko Watanabe
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  5. Hiroyoshi Suzuki
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  6. Mika Watanabe
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  7. Shigeo Kure
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  8. Teiji Tominaga
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Correspondence to Masayuki Kanamori.

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Kajitani, T., Kanamori, M., Saito, R. et al. Three case reports of radiation-induced glioblastoma after complete remission of acute lymphoblastic leukemia. Brain Tumor Pathol 35, 114–122 (2018). https://doi.org/10.1007/s10014-018-0316-1

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  • DOI: https://doi.org/10.1007/s10014-018-0316-1

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