Unique Case Report of a Meningeal Sarcoma Arising during Ongoing Treatment for Progressing Intraparenchymal Glioma

Abstract

Radiation-induced sarcomas in the brain are extremely rare, usually occur with an average latency of 9 years, and are associated with poor outcomes. Latency periods shorter than 1 year may indicate a genetic predisposition such as Li-Fraumeni syndrome. A 34-year-old man underwent initial tumor resection and radiation therapy for a World Health Organization (WHO) Grade II Astrocytoma. Within 6 months, the tumor recurred as WHO Grade III and was treated with temozolomide and then bevacizumab. Despite the patient's apparent improving condition, MRI revealed new dural-based lesions 10 months after radiation therapy and identified as high-grade sarcoma. The patient resumed bevacizumab, began NovoTTF treatment for progressing glioma, and ifosfamide/doxorubicin for the sarcoma. Genetic testing revealed no pathogenic mutation in the TP53 gene. Ultimately, treatment was unsuccessful and the patient succumbed to glioma and sarcoma within 2 years of initial diagnosis. This case was unique due to the rapidly progressing glioma and sudden appearance of a high-grade sarcoma. It is unusual to have two separate intracranial primary cancers with each requiring a different chemotherapy regimen. We discuss the difficulty of simultaneously treating with separate chemotherapy regimens. It remains unclear whether the sarcoma was induced by the radiation treatment or a genetic predisposition.

Radiotherapy-Related Dural Sarcoma and Its Management: Case Report

“…2 Meningeal sarcoma was detected after ten months in a patient with astrocytoma treated by RT. 9 In the case of medulloblastoma treated by RT, malignant fibrous histiocytoma developed eight years later. 10 In an ependymoma case postoperatively treated by RT, meningeal sarcoma developed seven and a half years later.…”

Malignant spindle cell tumors of the posterior fossa in children: case series and review of management

“…19 A wide variety of histological subtypes, including malignant fibrous histiocytoma, chondrosarcoma, rhabdomyosarcoma, liposarcoma, fibrosarcoma, angiosarcoma, leiomyosarcoma, and epithelioid sarcoma, have been reported. 21 Neuroimaging findings are typically nonspecific, and these lesions are usually described as rapidly growing heterogeneous tumors with cystic, solid, or complex components. 19 When a malignant spindle cell neoplasm shows highgrade pathological features with numerous mitoses, and investigation with immunohistochemical and molecular 18,19 1 case was in the posterior fossa.…”