Late appearance of meningioma at the site of partially removed oligodendroglioma

Case report

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✓ A case is presented in which a meningioma and a glioma grew in the region where, 23 years before, a glial tumor had been partially removed and irradiated. The authors suggest that surgical trauma and ionizing radiation may have influenced the tumor's development.

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Address reprint requests to: Julio H. Garcia, M.D., University of Maryland Hospital, 22 South Greene, Baltimore, Maryland 21201.

© AANS, except where prohibited by US copyright law.

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Figures

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    Histological preparations of the first tumor, removed at the age of 17. The cells have large nuclei and scanty cytoplasm; no specific patterns break the monotony of their arrangement. Left: PTAH, × 40. Right: PTAH, × 100.

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    Arteriography of tumor recurrence. Upper Left: Lateral projection shows downward and posterior displacement of the callosomarginal and pericallosal arteries and branches of the anterior Sylvian artery. The anterior ethmoidal (ant eth) branch of the ophthalmic artery can be seen entering the anterior fossa and supplying the anterior falx artery (ant falx). Upper Right: Enlargement of this view shows that the periphery of the large tumor (outlined by arrows) is delimited by abundant newly formed vessels and an early draining vein (most anterior arrow); both of these features are commonly seen in gliomas. In the upper portion of the tumor there is a “sunburst” appearance (crossed arrow) supplied by the anterior falcial and a branch of the pericallosal arteries, findings characteristic of a meningioma. Lower Left: Anteroposterior view shows a frontal shift of the pericallosal and callosomarginal arteries. The anterior falx artery ascends to the left of the midline and increases in caliber slightly as it reaches the upper part of the tumor. A large polar branch of the callosomarginal artery (arrow) enters the upper portion of the tumor.

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    Photomicrographs characteristic of the two neoplasms resected 23 years after the first tumor removal. Upper: Meningiomatous portion with elongated, fusiform cells arranged in whorls. Psammoma bodies, now shown, were also easily demonstrated. H & E, × 25. Lower: Gliomatous portion of tumor. Small cells with a scanty cytoplasm are arranged in pseudorosette patterns consistent with oligodendroglioma. Lower Left: H & E, × 25. Lower Right: PTAH, × 100.

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