지연성 방사선 뇌괴사 -1예 보고-
Delayed Radionecrosis of the Brain -A case simulating recurrent glioma-
소속 상세정보
강신광/Shin Kwang Khans
송준호/이규호/주인욱/지제근/Jun Ho Song/Kyu Ho Lee/In Wook Choo/Je G. Chi.
KMID : 0357919880220030360
Abstract
뇌종양의 방사선 치료후 발생한 지연성 방사선 뇌괴사 1예를 경험하여 문헌 고찰과 함께
보고한다. 환자는 35세 여자로 4년 전 좌측 전두엽에 발생한 뇌종양을 제거한 후 약 6주 동
안 총 5400 rads의 방사선 치료를 받았다. 당시의 병리학적 진단은 grade Ⅱ성상교종 이었
다. 환자는 그후 건강히 지내다 입원 20일 전부터 의식상태가 혼미해지기 시작하였다. 전산
화 단층 촬영상 우측 전두엽 및 좌측 두정엽에서 저음영의 커다란 종괴가 관찰되어 재발성
성상교정이 의심되었으나 생검 결과 특징적인 헐관 변화와 신경 교증을 동반하는 뇌조직의
괴사가 관찰되어 방사선 조사에 의한 지연성 뇌괴사임이 확인되었다.
#초록#
An appreciation of the radiation changes in the brain adjacent to radiated glioma is of
considerable importance from both clinical and pathological standpoint because the
alteration in the brain parenchyma may result in a picture that mimics recurrence of the
neoplasm.435 years old woman was admitted because of deterioration of consciousness
which has started about 20 days ago. Past history revealed removal of left frontal brain
tumor 4 years earlier and the diagnosis was grade Ⅱ astroma. Postoperative radiation
was done at that time. Sice then, she has been doing well. Computerized tomogram
showed an ill defined huge low density mass at right frontal and left posterior parietal
areas, which was irregularly enhanced in postcontrast study. unlikely to the usual brain
tumors, there was no mass effect on adjacent structures. Histologically acellular necrotic
zone was alternating with hypercellular zone and most striking changes were vascular
and glial reaction. Most of the vessels showed acellular hyliane thickening of their wall
and some vessels were almost completely occluded. There was marked glial proliferation
with considerable cellular and nuclear irregularities. Gemistocytic astrocytes were
frequently seen and some were multinucleated.
키워드
Radiation necrosis; Brain; Astrocytoma;
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