• Journal of Korean Neurosurgical Society
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• v.40 no.1
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• pp.54-57
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• 2006

Central nervous system[CNS] involvement of acute lymphoblastic leukemia may occur. However, CNS involvement as a first manifestation of leukemia is very rare. An 8-year-old girl complained of a backache after playing in the water. Neurological examination detected progressing paraparesis. Magnetic resonance imaging[MRI] of the thoracolumbar spine showed a well-circumscribed homogeneous posterior extradural mass lesion extending from T7 to T9. MRI of the brain showed diffused fatty marrow replacement of the calvarium and the skull base. We report a patient with epidural Burkitt's lymphoma of the thoracic and lumbar vertebra causing compression of the spinal cord after pathologic evaluation. The tumor consisted mainly of lymphoblastic cells, which were identical to those originally seen in the bone marrow aspiration and biopsy. After decompressive laminectomy she began consolidation chemotherapy.

• Journal of Korean Neurosurgical Society
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• v.60 no.5
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• pp.534-539
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• 2017

Objective : Patients with hematological malignancies frequently encounter spine-related symptoms, which are caused by disease itself or process of treatment. However, there is still lack of knowledge on their epidemiology and clinical courses. The purpose of this article is to review clinical presentations and surgical results for spinal involvement of hematologic malignancies. Methods : From January 2011 to September 2014, 195 patients (98 males and 97 females) suffering from hematological malignancies combined with spinal problems were retrospectively analyzed for clinical and radiological characteristics and their clinical results. Results : The most common diagnosis of hematological malignancy was multiple myeloma (96 patients, 49.7%), followed by chronic myeloid leukemia (30, 15.2%), acute myeloid leukemia (22, 11.2%), and lymphoma (15, 7.56%). The major presenting symptoms were mechanical axial pain (132, 67.7%) resulting from pathologic fractures, and followed by radiating pain (49, 25.1%). Progressive neurologic deficits were noted in 15 patients (7.7%), which revealed as cord compression by epidural mass or compressive myelopathy combined with pathologic fractures. Reconstructive surgery for neurologic compromise was done in 16 patients. Even though surgical intervention was useful for early paralysis (Frankel grade D or E), neurologic recovery was not satisfactory for the progressed paralysis (Frankel grade A or B). Conclusion : Hematological malignancies may cause various spinal problems related to disease progression or consequences of treatments. Conservative and palliative treatments are mainstay for these lesions. However, timely surgical interventions should be considered for the cases of pathologic fractures with progressive neurologic compromise.

• Radiation Oncology Journal
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• v.12 no.1
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• pp.33-42
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• 1994

From 1982 to 1991, sixteen Patients with primary non-Hodgkin's lymphoma of the central nervous system(CNS) were seen at Kyung Hee University Hospital. The most common subtypes were large, noncleaved cell lymphoma and immunoblastic lymphoma of B cells. Lesions most commonly involved were the parietal lobes and/or deep nuclei. Positive cerebrospinal fluid cytology was rare at initial presentation. Sixteen patients were treated with surgical biopsy or resection followed by whole brain radiotherapy at a median dose of 40 Gy(range=30-50 Gy) with variable boost doses. Of 16 patients who underwent surgery and postoperative radiotherapy, fourteen patients died between 2 and 49 months following treatment, and two are alive with no evidence of disease at 8 and 22 months. The 1-and 2-year survival rates were 55.6$ \% $ and 34.7$ \% $, respectively with 12 months of median survival. Patterns of failure were analyzed in eleven patients of total 16 patients. Failure at the original site of involvement was uncommon after radiotherapy treatment. In contrast, failure in the brain at sites other than those originally invovled was common in spite of the use of whole brain irradiation. Failure occurred in the brain 11/16(68.7$ \% $), in spinal axis 4/16(25.0$ \% $). The age, sex, location of involvement within CNS, numbers of lesion, or radiation dose did not influence on survival. The authors conclude that Primary CNS lymphoma is a locally aggressive disease that is poorly controlled with conventional radiation therapy. The limitation of current therapy for this disease are discussed, and certain promising modality should be made in regarding the management of future patients with this disease.

• Journal of Korean Neurosurgical Society
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• v.58 no.4
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• pp.389-392
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• 2015

Brown tumors also called as osteoclastomas, are rare nonneoplastic lesions that arise in the setting of primary or secondary hyperparathyroidism. Parathyroid adenomas or hyperplasia constitute the major Brown tumor source in primary hyperparathyroidism while chronic renal failure is the leading cause in secondary hyperparathyroidism. Most of the patients with the diagnosis of primary hyperparathyroidism present with kidney stones or isolated hypercalcemia. However, nearly one third of patients are asymptomatic and hypercalcemia is found incidentally. Skeletal involvement such as generalized osteopenia, bone resorption, bone cysts and Brown tumors are seen on the late phase of hyperparathyroidism. The symptoms include axial pain, radiculopathy, myelopathy and myeloradiculopathy according to their locations. Plasmocytoma, lymphoma, giant cell tumors and metastates should be ruled out in the differential diagnosis of Brown tumors. Treatment of Brown tumors involve both the management of hyperparathyroidism and neural decompression. The authors report a very rare spinal Brown tumor case, arisen as the initial manifestation of primary hyperparathyroidism that leads to acute paraparesis.

• Radiation Oncology Journal
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• v.11 no.1
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• pp.79-82
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• 1993

From October 1989 to March 1992, ten patients diagnosed as primary central nervous system (CNS) lymphoma were treated with radiation therapy at Asan Medical Center. To obtain pathologic diagnosis, five patients had stereotactic biopsy and the others underwent craniotomy & tumor removal. According to the classification by International Working Formulation, seven of 10 patients showed diffuse large cell types and the remaining 3 had diffuse mixed cell types. Computed tomographic scans of the brain disclosed solitary (6 cases) or multiple (4 cases) intracranial lesions. All patients received 4000 cGy/20 fx to the whole brain followed by an additional 2000 cGy/10 fx boost to the primary lesion. Six patients with initial cerebrospinal fluid (CSF involvement were treated with whole brain irradiation and intrathecal Methotrexate (IT-MTX) chemotherapy. One of them received an additional spinal irradiation after 3 cycles of IT-MTX chemotherapy because of MTX induced arachnoiditis. One patient received 3 cycles of systemic chemotherapy prior to rodiation therapy and one received 5 cycles of salvage chemotherapy for recurrence. With a median follow up time of 8 months, all patients were followed from 7 to 26 months. Radiologically seven patients showed complete remission and the remaining three showed partial remission at one month after radiotherapy. The 1 and 2 year survival rate was $86{\%}\;and\;69{\%}$ respectively. Until now, two patients expired at 7 and 14 months. These patients developed extensive CSF seeding followed by local failure. Considering initial good response to radiation therapy and low incidence of extraneural dissemination in primary CNS lymphoma, we propose to increase total tumor dose to the primary lesion by hyperfractionated radiotherapy or stereotactic radiosurgery. For the patients with CSF involvement at diagnosis, we propose craniospinal irradiation with IT MTX chemotherapy.

• The Korean Journal of Nuclear Medicine
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• v.28 no.3
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• pp.384-390
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• 1994

Authors retrospectively compared the 99mTc MDP bone scans and corresponding MR imagings in 20 patients with histologically proven malignancy, Mean interval of the two studies was 16.6 days, Cancer diagnosis Included 8 lung, 2 each of colon, breast, stomach, 1 each of prostate, thyroid, malignant lymphoma and 3 adenocarcinoma of unknown primary site. Of the 105 regions compared, :t6 regions were positive for metastases in bone scans or MR imagings. 30 regions(65.2%) were positive by bone scan and 44 regions(95.7%) by MR imaging. 87 regions(82.9%) were concordantly positive or negative by bone scan and MR imaging, but 18 regions(17.1%) were discordant. In the discordant regions, 16 regions positive in MR imaging were negative in bone scan. The greatest number of discordant findings occured in the cervical region and in the patient with stomach cancer. Our results suggest that the sensitivity of MR Imaging is greater than that of bone scan in detecting spinal metastases. And bone scan is useful screening test of metastasis for evaluating entire skeleton including spine.