A rare case of central nervous system amyloidoma treated with fractionated radiotherapy.
A 54-year-old female presented with multiple episodes of emesis, intractable headaches, worsening balance, and slowly progressive right facial weakness. Imaging demonstrated a 3-cm mass in the left internal capsule and corona radiata region with associated edema, mass effect, and midline shift concerning for high-grade glioma, lymphoma, or brain metastasis. Stereotactic biopsy of the mass was consistent with amyloid deposition. Systemic workup for amyloidosis was negative, and the mass was thought to represent a focal tumor-like deposit of amyloid, also referred to as "amyloidoma." In the absence of systemic disease, therapy, which can include surgery or radiotherapy, can be directed at the local process. The location of the patient's lesion was not amenable to resection; therefore, she was treated with fractionated radiotherapy of 30.6 Gy at 1.8 Gy per fraction. Serial brain MRI demonstrated stability 18 months out from therapy. To the authors' knowledge, this is the first documented case of focal fractionated radiotherapy for CNS amyloidoma. The authors concluded that radiotherapy can prevent further progression of amyloidomas in anatomical locations that prohibit resection.
Departments of 1 Radiation Oncology.
Teresa
T
Meier
Radiology.
J Michael
JM
Hazenfield
Hematology Oncology.
Saulius
S
Girnius
Pathology, and.
Matthew
M
Hagen
Neurosurgery, University of Cincinnati Medical Center, Cincinnati, Ohio.
Ronald E
RE
Warnick
Departments of 1 Radiation Oncology.
Jordan
J
Kharofa
D000682:Amyloid / Q000096:biosynthesis; D001932:Brain Neoplasms / Q000378:metabolism / Q000532:radiotherapy*; D019583:Dose Fractionation, Radiation; D005260:Female; D006801:Humans; D008875:Middle Aged
D000682:Amyloid
AL = amyloid light chain; CNS; CNS = central nervous system; Cho = choline; Cr = creatine; FDG = fluorine-18–labeled fluorodeoxyglucose; MRI; NAA = N-acetylaspartate; amyloidoma; radiotherapy