[Astrocytoma of the cerebellum and adverse effects of radiotherapy. A case report].
BACKGROUND
Although the nervous system is highly resistant to radiations, some cases have been reported about adverse effects of radiotherapy on patients with brain tumors. The following delayed effects have been observed: coagulation necrosis of all the cellular elements, fibrinoid and hyaline changes on the walls of the neoformed blood vessels, together with endothelial proliferation and perivascular fibrosis, reactive astrocytes, some of them with bizarre nuclei, as well as telangiectasia, hemorrhage and hemorrhagic infarcts. Telangiectasia and associated hemorrhage may occur in any of the irradiated zones of the brain.


METHODS
The present case is an example in which the indication of radiotherapy was due to an anatomopathological overdiagnosis. The first biopsy was diagnosed as a grade II cerebellar astrocytoma, after which 20 radiotherapy sessions were indicated. Nine years after that, a second operation was performed. This second biopsy revealed areas of fibrosis, hemorrhages, calcifications, necrosis, and thick hyaline-walled blood vessels. No tumor infiltration was observed. After an unfavorable evolution, the patient died. The microscopical study of the autopsy material revealed an area of neoplastic infiltration which was well defined as a pylocitic astrocytoma of the cerebellum. The rest of the cerebellum sections evidenced damage corresponding to an adverse effect of radiotherapy, particularly large zones of telangiectasia.


CONCLUSIONS
It is stated that the patient s death was not because of the tumor. The adverse effects of radiotherapy, interpreted as tumor remains, motivated the second operation that generated complications causing the patient s death.
Galarraga-Inza
J
J
Laboratorio deAnatomía Patológica, Instituto de Neurología y Neurocirugía, La Habana, 10400, Cuba.
Gómez-Suárez
H
H
Coro-Antich
R M
RM
Domínguez-Alvarez
C
C
D000293:Adolescent; D001254:Astrocytoma / Q000175:diagnosis / Q000532:radiotherapy* / Q000601:surgery; D001284:Atrophy / Q000209:etiology / Q000473:pathology; D001479:Basal Ganglia / Q000000981:diagnostic imaging / Q000473:pathology; D002528:Cerebellar Neoplasms / Q000175:diagnosis / Q000532:radiotherapy* / Q000601:surgery; D017809:Fatal Outcome; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009367:Neoplasm Staging; D011183:Postoperative Complications; D011878:Radiotherapy / Q000009:adverse effects*; D013345:Subarachnoid Hemorrhage / Q000209:etiology* / Q000473:pathology; D013684:Telangiectasis / Q000209:etiology*; D014057:Tomography, X-Ray Computed