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Calcified cerebral necrosis following ALL therapy
Journal of Cancer Research and Clinical Oncology
|January 1, 1981
Summary
Unusual calcified cerebral necrosis was found in a child with acute lymphoblastic leukemia (ALL) after chemotherapy and cranial irradiation. This rare finding highlights the complex multifactorial pathogenesis of treatment-related brain damage.
Area of Science:
- Neuropathology
- Pediatric Oncology
- Radiotherapy
Background:
- A 13-year-old female with acute lymphoblastic leukemia (ALL) underwent prolonged therapy.
- Treatment included high-dose cytostatic therapy and cranial irradiation.
Observation:
- Progressive cerebral damage was noted after the second cycle of therapy.
- Autopsy revealed extensive calcified cerebral necrosis, particularly in the medullar brain layers.
- Necroses measured up to 5 cm, with fibrous vessels, thickened walls, and obstructed lumina.
Findings:
- Pathoanatomic examination showed recurrent meningosis and leukemic encephalosis.
- Calcified necroses were predominantly located near the ventricular area.
- Cerebral cortex was largely spared, while medullar layers showed significant tissue destruction.
Implications:
- A multifactorial pathogenesis is proposed, involving methotrexate toxicity, irradiation effects, and vascular involvement.
- Leukemic infiltration of vascular walls and tumor emboli contributed to lumen obstruction and tissue damage.
- Poor blood supply in border zones may explain the preferential necrosis location, suggesting a complex interplay of factors in treatment-related cerebral injury.