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This article is part of the supplement: 35te Tagung der Pathologen am Oberrhein/35th Meeting of Pathologists of the Upper Rhine Region (PATOR)

Open Access Oral presentation

Late effects of radiation on central nervous system

I Sinicina1*, K Bise2 and H Pankratz1

  • * Corresponding author: I Sinicina

Author affiliations

1 Institut für Rechtsmedizin, LMU, München, Germany

2 Zentrum für Neuropathologie und Prionforschung, LMU, München, Germany

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Citation and License

Diagnostic Pathology 2007, 2(Suppl 1):S18  doi:10.1186/1746-1596-2-S1-S18


The electronic version of this article is the complete one and can be found online at:


Published:14 March 2007

© 2007 Sinicina et al; licensee BioMed Central Ltd.

Aims

Primary germ cell tumors of the nervous system account for only 1% of all brain tumors. Traditionally, the treatment of intracranial germinomas has been craniospinal irradiation, which led to a long-term survival of more than 90%. The doses applied have had a wide range, with the mean dose of approximately 36 Gy. The potential late irradiation effects include growth retardation, endocrine deficits and second malignancies. The longest reported interval for late delayed irradiation reactions was 7 1/2 years.

Methods

A 14-year-old boy presented in a pediatric clinic in 1983 with a beginning bitemporal hemianopsia. A tumour in the suprasellar region was diagnosed and classified after an incomplete resection as a germinoma. The remaining tumor mass was irradiated. After an uneventful period of 3 years, the tumour dissemination along the liquor way was suspected. The radiation encompassed the entire spinal axis and cranium and resulted in a long-term remission with a good quality of life for 17 years. In 2004, a hyperdense structure protruding in the forth ventricle was seen in MR scans. Three months later, the patient was found dead in his bed.

Results

On post mortem examination there were no pathologic findings on the inner organs. Intoxication was ruled out. Within the dorsal part of the brain stem an exuberant formation of a collagen rich scar, which corresponded in a position to the structure seen in MR scans, was found. A marked microglia activation was evident in CR 3/34 immunostaining.

Conclusion

For the first time active persistent changes in the irradiated brain areas were described 17 years after the last radiation therapy of germinoma.