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Journal of Clinical Oncology, Vol 23, No 33 (November 20), 2005: pp. 8535-8536 © 2005 American Society of Clinical Oncology. DOI: 10.1200/JCO.2004.00.6817
Side Effects Related to Cancer TreatmentCASE 3. Primary Cerebral Lymphoma After Radiotherapy for Recurrent MeningiomaDepartments of Medicine, Neurosurgery and Pathology, Queen Mary Hospital, Hong Kong A 70-year-old HIV-negative man presented with sudden onset of right-sided weakness. He has history of repeated craniotomy for recurrent parasagittal meningioma for 17 years, and last received surgical debulking and radiotherapy (RT; 38 Gy) 3 years ago. A computed tomography scan showed a left thalamic contrast-enhancing necrotic lesion (Fig 1A, arrow), suggestive of glioblastoma multiforme. Open biopsy and debridement showed an aggressive B-cell lymphoma (Fig 1B) with high Ki67 proliferative staining (70% positive) but negative for EBER. Cytogenetic analysis showed classical c-myc translocation suggestive of Burkitt’s lymphoma (Fig 1C; 46-49, XY, dup(1)(q12q42), t(8;14)(q24;q32) [3], +add(6)(q11) [5], +X, +7 [9]), and staging showed localized disease. Radiotherapy was planned, but 6 days later, fleshy tumor nodules were noted on the craniotomy sutures (Fig 1D, arrow). Biopsy showed lymphoma involvement, and the patient died shortly afterwards.
Primary cerebral lymphomas in Chinese patients are mostly EBER-negative localized disease in immunocompetent hosts.1 Primary cerebral Burkitt’s lymphoma is rare, and the aggressive direct outward spread of lymphoma via the surgical tract is hitherto unreported.2 It is unclear whether the unusual tumor is related to recurrent meningioma or previous radiotherapy. Most reports of concomitant or sequential cerebral lymphoma and meningioma are chance findings of small incidental meningiomas.3,4 Lymphoma following recurrent meningioma is rare, and the older age of presentation did not favor a hereditary cancer-prone syndrome. On the other hand, lymphoma is also uncommon among secondary brain cancers after cranial RT.5,6 However, some studies suggested a wider variety of secondary cerebral cancers after cranial RT, with long latencies of up to 15 years.7 Hence, despite the long time lag, an association with previous meningioma and radiation cannot be excluded in our case. Authors’ Disclosures of Potential Conflicts of Interest The authors indicated no potential conflicts of interest.
REFERENCES 1. Au WY, Chan AC, Srivastava G, et al: Incidence and pathology of primary brain lymphoma in Hong Kong Chinese patients. Leuk Lymphoma 37:175-179, 2000[Medline] 2. Monabati A, Rakei SM, Kumar P, et al: Primary burkitt lymphoma of the brain in an immunocompetent patient: Case report. J Neurosurg 96:1127-1129, 2002[Medline] 3. Ildan F, Bagdatoglu H, Boyar B, et al: Combined occurrence of primary cerebral lymphoma and meningioma. Neurosurg Rev 18:45-48, 1995[Medline] 4. Slowik F, Jellinger K: Association of primary cerebral lymphoma with meningioma: Report of two cases. Clin Neuropathol 9:69-73, 1990[Medline] 5. Chang SM, Barker FG 2nd, Larson DA, et al: Sarcomas subsequent to cranial irradiation. Neurosurgery 36:685-690, 1995[Medline]
6. Walter AW, Hancock ML, Pui CH, et al: Secondary brain tumors in children treated for acute lymphoblastic leukemia at St Jude Children’s Research Hospital. J Clin Oncol 16:3761-3767, 1998 7. Amirjamshidi A, Abbassioun K: Radiation-induced tumors of the central nervous system occurring in childhood and adolescence: Four unusual lesions in three patients and a review of the literature. Childs Nerv Syst 16:390-397, 2000[CrossRef][Medline]
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Copyright © 2005 by the American Society of Clinical Oncology, Online ISSN: 1527-7755. Print ISSN: 0732-183X
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