Collision in the inferior olive: hypertrophic olivary degeneration complicated by radiation necrosis in brainstem primitive neuroendocrine tumor.
Hypertrophic olivary degeneration (HOD) is caused by disruption of the triangle of Guillain and Mollaret. We describe a child with a primitive neuroendocrine tumor who developed an expansile nonenhancing lesion in the olive after surgery and radiation therapy. Diffusion tensor imaging and tractography showed disruption of the central tegmental tract consistent with HOD. Subsequent transient enhancement of the olive was consistent with early radiation injury. Knowledge of coexisting complications such as HOD and radiation injury is essential for proper management.
Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
Patricia
P
Litkowski
Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.|Department of Brain Tumor Center, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
Robert J
RJ
Young
Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.|Department of Brain Tumor Center, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
Suzanne L
SL
Wolden
Department of Neurosurgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.|Department of Brain Tumor Center, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
Mark M
MM
Souweidane
Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.|Department of Brain Tumor Center, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
Sofia
S
Haque
Department of Pediatrics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.|Department of Brain Tumor Center, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
Stephen W
SW
Gilheeney
D020295:Brain Stem Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D002675:Child, Preschool; D056324:Diffusion Tensor Imaging / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006984:Hypertrophy / Q000000981:diagnostic imaging / Q000473:pathology; D008991:Monitoring, Physiologic / Q000379:methods; D009336:Necrosis / Q000000981:diagnostic imaging / Q000473:pathology; D009410:Nerve Degeneration / Q000209:etiology / Q000473:pathology*; D018358:Neuroendocrine Tumors / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D009847:Olivary Nucleus / Q000473:pathology* / Q000528:radiation effects; D011832:Radiation Injuries / Q000175:diagnosis* / Q000473:pathology; D011859:Radiography; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects* / Q000379:methods; D018570:Risk Assessment; D013997:Time Factors; D016896:Treatment Outcome