Search

Malignant fibrous histiocytoma (MFH) is common among the soft-tissue sarcoma and especially occurs in the retroperitoneum and the four extremities. However primary intracranial MFH is an extremely rare occurrence. A case with primary intracranial MFH associated with peritumoral hemorrhage is reported. A 81-year-old woman was admitted to our department with impaired consciousness and left hemiparesis. On admission, she was drowsy. Computed tomography (CT) scans revealed a low density mass lesion of 4.5 x 3.5 x 6.0cm in diameter, which was surrounded by a high density area suggesting hematoma, in the right frontal lobe adjacent to the falx cerebri. The low density mass was homogeneously enhanced by contrast medium. Magnetic resonance imaging revealed that the mass was hypointense on T1 weighted image and hyperintense on T2 weighted image. After administration of Gd-DTPA, the mass was homogeneously enhanced and the falx cerebri was also enhanced at the site of attachment. Right carotid angiogram showed a tumor stain fed by the anterior cerebral artery. On operation, bleeding was encountered between the tumor and the falx cerebri on opening the dura mater. Hematoma existed between the tumor and the normal cerebral parenchyma. The tumor was sharply demarcated and didn't invade the normal cerebral parenchyma or the falx cerebri, so we considered that the tumor originated from the meninges. Histologically, pleomorphic spindle cells in atypical storiform pattern were observed. Multinucleated giant cells were also seen. This case suggested to us that primary intracranial MFH may be associated with intracranial hemorrhage.

One hundred ten patients with brain metastases (76 lung cancer, 11 breast cancer, 7 colorectal cancer and others) were treated with radiotherapy, and the results were retrospectively evaluated. Neurologic symptoms were improved in 66% of patients. The relationship between improvement of neurologic symptoms and several factors, including irradiation dose, primary lesion, histology, term between first treatment and recurrence, clinical symptoms and CT findings, was analyzed. There was no significant correlation between symptom relief and these factors except for the number of metastatic lesions. Four of 110 patients could survive more than 2 years after radiotherapy: one with lung cancer, one with breast cancer, one with rectum cancer and one with uterine cancer. The factors that were analyzed for symptom relief were also studied to determine their effect on the survival of lung cancer patients with brain metastases. The patients who had higher dose irradiation (50 Gy) of improvement of neurological symptoms after radiotherapy survived significantly longer than those who had 30 Gy of irradiation or no symptom relief. Multivariate analysis of these factors showed that improvement of symptoms and irradiation dose were similarly important prognostic factors, whereas the others were not correlated with survival.

Forty-nine postoperative cancer patients with a recurrent cervical cancer at the vaginal stump were treated with high-dose intracavitary brachytherapy with or without external irradiation. The intervals between their previous surgery and the vaginal recurrence ranged widely, from 4 months to 36 years. The overall 10-year survival rate after radiotherapy was 48%. The patients were classified into two groups, according to the tumor size that was evaluated by rectovaginal examination at time of recurrence, that is, one group without a palpable mass at the vaginal stump and one with a palpable mass. The 10 year-survival rate with or without the palpable mass was 8% and 80%, respectively. External irradiation combined with brachytherapy could not modify the survival rate of those that had been treated by brachytherapy alone in the group without the palpable mass. On the other hand, the incidence of late intestinal complications was increased by the combination of external irradiation. This result suggests that the most important prognostic factor in cases of a recurrent cervical cancer at the stump is the tumor size.