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Glioblastoma after AVM radiosurgery. Case report and review of the literature

  • Clinical Article - Brain Tumors
  • Published:
Acta Neurochirurgica Aims and scope Submit manuscript

Abstract

Background

Stereotactic radiosurgery (SRS) is considered to be a relatively safe procedure in cerebral arteriovenous malformation management. There are very few reported cases of SRS-associated/induced malignancies.

Methods

We show the case of a 21-year-old female who presented with a 21-mm3 ruptured AVM in the right mesial frontocallosal region. Embolization and/or radiosurgery was proposed. She preferred radiosurgery. The AVM was treated with CyberKnife® SRS. Results: She presented behavior changes 6 years after SRS. MRI showed a right subcortical frontal lesion with increased perfusion, more consistent with high-grade glioma. The lesion’s center was within the irradiated region of the previous SRS, having received an estimated radiation dose of 4 Gy. Pathological examination noted a hypercellular tumor showing astrocytic tumor cells with moderate pleomorphism in a fibrillary background, endothelial proliferation, and tumor necrosis surrounded by perinecrotic pseudopalisades. Numerous mitotic figures were seen. The appearances were those of glioblastoma, WHO grade IV, with neuronal differentiation. SRS-associated/-induced GBM after treatment of a large AM is exceptional. SRS-associated/-induced malignancies are mostly GBMs and occur on average after a latency of 9.4 years, within very low-dose peripheral regions as well as the full-dose regions; 33.3 % of patients were under 20 years at the time of SRS, and in 66 % the lesion treated was a vascular pathology.

Conclusion

Although it is unlikely that the risk of radiation-induced cancer will change the current standard of practice, patients must be warned of this potential possibility before treatment.

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Acknowledgments

We thank Dr. Ina Milanesi, Dipartimento di Neurochirurgia, U.O. Radioterapia, CyberKnife, Fondazione IRCCS Istituto Neurologico "C. Besta," Milan, Italy, for assistance with preparing the manuscript.

Conflict of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge, or beliefs) in the subject matter or materials discussed in this manuscript.

Patient consent

The next of kin has consented to the submission of the case report for submission to the journal.

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Authors and Affiliations

  1. Service of Neurosurgery, University Hospital Centre “Mother Teresa”, Kongresi i Manastirit, Nr. 210, Tirane, Albania

    Artur Xhumari & Mentor Petrela

  2. Service of Radiology, University Hospital Centre “Mother Teresa”, Tirana, Albania

    Arben Rroji & Eugen Enesi

  3. Service of Pathology, University Hospital Centre “Mother Teresa”, Tirana, Albania

    Teona Bushati

  4. Service of Neurosurgery, University Hospital San Carlos, Madrid, Spain

    Kita Sallabanda Diaz

  5. SRS Coordinator of Grupo IMO, Madrid, Spain

    Kita Sallabanda Diaz

Authors
  1. Artur Xhumari
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Correspondence to Mentor Petrela.

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Xhumari, A., Rroji, A., Enesi, E. et al. Glioblastoma after AVM radiosurgery. Case report and review of the literature. Acta Neurochir 157, 889–895 (2015). https://doi.org/10.1007/s00701-015-2377-9

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  • DOI: https://doi.org/10.1007/s00701-015-2377-9

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