RESUMO
Single meningiomas are histologically classified as benign tumors, but clearly malignant types have been encountered. The standard mode of management is total macroscopic removal with excision of the dural attachment and abnormal bone, if there is any. Despite this aggressive surgery, recurrence rates of approximately 9% have been reported with the removal of benign tumors, and the rate is much higher with the removal of malignant meningiomas. Recurrence most frequently occurs at the original tumor site and is most often explained by incomplete removal, which, in turn, is a function of the anatomic location of the tumor. Less common are regional recurrences, which may be explained on the basis of the multicentric origin of meningiomas. This theory may also explain the rare entity, "multiple meningioma." This article documents an unexpected regional recurrence of meningioma. The pertinent literature is reviewed.
Assuntos
Neoplasias Meníngeas/patologia , Meningioma/patologia , Recidiva Local de Neoplasia/patologia , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Terapia Combinada , Humanos , Masculino , Neoplasias Meníngeas/diagnóstico por imagem , Neoplasias Meníngeas/terapia , Meningioma/diagnóstico por imagem , Meningioma/terapia , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/diagnóstico por imagem , Recidiva Local de Neoplasia/terapia , Cuidados Pós-Operatórios , Tomografia Computadorizada por Raios XRESUMO
We retrospectively studied 44 patients with testicular seminoma treated with primary radiation therapy at the Bowman Gray School of Medicine from 1972 through 1982. The 26 patients with stage I disease received infradiaphragmatic irradiation. Eleven of the 12 with stage II disease, the three with stage III disease, and three with retroperitoneal disease received irradiation to the mediastinum and infradiaphragmatic area. The three-year survival rate without evidence of disease was 100% for stage I. For stage II, the rate was 92% with radiation therapy alone and 100% with salvage therapy. In two patients with stage III disease radiation therapy failed, but both had bulky abdominal disease. Only one died of seminoma. One of the patients with retroperitoneal tumor had unsuccessful radiation therapy but was salvaged with chemotherapy. Neither the diagnosis of anaplastic seminoma in nine patients nor elevated preorchiectomy beta-HCG levels in four patients affected their prognosis. In our series, primary radiation therapy with proper salvage therapy yielded 98% survival.