Malignant transformation of a vestibular schwannoma after gamma knife radiosurgery.
Malignant transformation of a vestibular schwannoma after gamma knife radiosurgery.
复制标题
DOI：
10.1016/j.wneu.2012.03.016
复制
发表时间：
2013-03
影响因子：
2
通讯作者：
V. Yanamadala;R. Williamson;D. Fusco;J. Eschbacher;P. Weisskopf;R. Porter
中科院分区：
文献类型：
--
作者：
V. Yanamadala;R. Williamson;D. Fusco;J. Eschbacher;P. Weisskopf;R. Porter
目的报告一例前庭神经鞘瘤放射外科术后恶变的病例，并回顾越来越多的描述原发性良性肿瘤放射外科术后恶变患者的文献，包括前庭神经鞘瘤。方法：46岁女性，表现为右侧面部感觉异常，影像学表现与右侧前庭神经鞘瘤一致（体积约18.5 cm 3）。患者在手术后6个月接受次全切除术，随后接受伽玛刀放射外科手术（GKRS）。初步组织学检查显示良性前庭神经鞘瘤，MIB-1标记指数为5.7%。在GKRS后43个月，患者再次接受良性前庭神经鞘瘤次全切除术（MIB-1标记指数7.4%）。在59个月后GKRS，她进行了第三次切除术，组织学显示坦率的恶性转化（MIB-1标记指数33.8%）。结论恶性前庭神经肿瘤是非常罕见的，只有18例已在文献中报道。我们的病人是第六例病理证实的恶性转化后放射外科手术，支持的论点，放射外科手术本身可能发挥了致病作用的转化。在组织学良性病变中，MIB-1标记指数升高可能会导致辅助放射外科治疗中恶变。
OBJECTIVETo report a single case of malignant transformation of a vestibular schwannoma after radiosurgery and review the growing body of literature describing patients with malignant transformation of primary benign tumors after radiosurgery, including vestibular schwannoma.METHODSA 46-year-old woman presented with right facial paresthesias and imaging consistent with a right-sided vestibular schwannoma (volume approximately 18.5 cm3).RESULTSThe patient underwent subtotal resection followed by Gamma Knife radiosurgery (GKRS) 6 months after surgery. Initial histology showed a benign vestibular schwannoma with an MIB-1 labeling index of 5.7%. At 43 months after GKRS, the patient underwent repeat subtotal resection of a benign vestibular schwannoma (MIB-1 labeling index 7.4%). At 59 months after GKRS, she underwent a third resection, and histology showed frank malignant transformation (MIB-1 labeling index 33.8%).CONCLUSIONSMalignant vestibular nerve tumors are extremely rare; only 18 cases have been reported in the literature. Our patient is the sixth pathologically confirmed case of malignant transformation after radiosurgery, supporting the contention that radiosurgery itself may play a causative role in transformation. In a histologically benign lesion, the presence of an elevated MIB-1 labeling index may predispose toward malignant transformation in the setting of adjuvant radiosurgery.