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Giant radiation-induced cavernous haemangioma before reduced-intensity bone marrow transplantation for acute lymphoblastic leukaemia

Bone Marrow Transplantation volume 54, pages 312–315 (2019)Cite this article

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Although performed less frequently, cranial irradiation is used to treat leukaemia and lymphoma and prevent tumour infiltration to the central nervous system (CNS). One of the late complications of cranial irradiation is radiation-induced cavernous haemangioma (RICH), which develops cumulatively over up to 10 years after cranial irradiation in ~40% patients [1,2,3]. Rather than radiation-induced secondary neoplasm, RICH is regarded as a vascular disorder caused by radiation-induced damage to small intracranial vessels [4]. Although asymptomatic, RICH is incidentally detected during imaging tests in most cases. Asymptomatic patients are only observed and not treated even after diagnosis [2, 5, 6]. Few cases of RICH developing after haematopoietic stem cell transplantation (HSCT) have been reported; however, there are no reports in which RICH was observed prior to transplantation nor is there any known method to manage RICH that develops during HSCT [6].

Here, we report the case of a 10-year-old boy with second relapse of acute lymphoblastic leukaemia (ALL) with a giant 30-mm RICH. Prior to conditioning, the patient developed haemorrhage and hydrocephalus that required sub-occipital craniotomy to excise the haemangioma. Reduced-intensity conditioning was performed ~1 month after craniotomy, followed by allogeneic bone marrow transplantation from an unrelated donor.

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Acknowledgements

This work was supported in part by funds for Grant-in-Aid for Scientific Research (C) from the Ministry of Education, Culture, Sports, Science and Technology of Japan (Grant Number #16K10034 to TN).

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Authors and Affiliations

  1. Department of Pediatrics, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan

    Aki Saito, Takuro Nishikawa, Shunsuke Nakagawa, Yuichi Kodama, Yasuhiro Okamoto & Yoshifumi Kawano

  2. Department of Neurosurgery, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan

    Tatsuki Oyoshi & Kazunori Arita

  3. Division of Pediatrics, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan

    Ai Yamada, Mariko Kinoshita & Hiroshi Moritake

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  1. Aki Saito
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  2. Takuro Nishikawa
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  4. Shunsuke Nakagawa
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  11. Yoshifumi Kawano
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Correspondence to Takuro Nishikawa.

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The authors declare that they have no conflict of interest.

Ethics approval and informed consent for publication

Informed consent was obtained from the patient to publish this case. The case report was approved by the Ethics Committee of Kagoshima University Hospital (approval number 180089).

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Saito, A., Nishikawa, T., Oyoshi, T. et al. Giant radiation-induced cavernous haemangioma before reduced-intensity bone marrow transplantation for acute lymphoblastic leukaemia. Bone Marrow Transplant 54, 312–315 (2019). https://doi.org/10.1038/s41409-018-0272-8

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