J Pathol Transl Med.  2022 Jan;56(1):16-21. 10.4132/jptm.2021.08.30.

Clinicopathological differences in radiation-induced organizing hematomas of the brain based on type of radiation treatment and primary lesions

• Kim MS
• Kim SH
• Chang JH
• Park M
• Cha YJ

• KMID: 2524225
• DOI: http://doi.org/10.4132/jptm.2021.08.30

Abstract

Background
Radiation-induced organizing hematoma (RIOH) is a sporadic form of cavernous hemangioma (CH) that occurs after cerebral radiation. RIOH lesions are distinct histologically from de novo CH; however, detailed research on this subject is lacking. In the present study, the clinical and histological features of RIOHs were evaluated based on causative lesions.
Methods
The present study included 37 RIOHs confirmed by surgical excision from January 2009, to May 2020, in Yonsei Severance Hospital. All cases were divided into subgroups based on type of radiation treatment (gamma knife surgery [GKS], n = 24 vs. conventional radiation therapy [RT], n = 13) and pathology of the original lesion (arteriovenous malformation, n = 14; glioma, n = 12; metastasis, n = 4; other tumors, n = 7). The clinicopathological results were compared between the groups.
Results
Clinical data of multiplicity, latency, and size and wall thickness of the original tumors and RIOHs were analyzed. The GKS group showed shorter latency (5.85 ± 4.06 years vs. 11.15 ± 8.27 years, p = .046) and thicker tumor wall (693.7 ± 565.7 μm vs. 406.9 ± 519.7 μm, p = .049) than the conventional RT group. Significant difference was not found based on original pathology.
Conclusions
RIOH is more likely to occur earlier with thick tumor wall in subjects who underwent GKS than in patients who underwent conventional RT. These results indicate the clinical course of RIOH differs based on type of treatment and might help determine the duration of follow-up.

Keyword

Radiation-induced organizing hematoma; Cavernous hemangioma; Gamma knife surgery; Radiation therapy; Latency

Figure

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  Fig. 1 The histology of radiation-induced organizing hematoma (RIOH) and de novo cavernous hemangioma (CH); Microscopically, RIOH shows a hematoma-like area composed of hyalinized vessels with fibrin and infiltrating foamy macrophages (A, B), and de novo CH consists of clusters of well-formed vascular lumens (C).

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  Fig. 2 Gamma knife surgery–induced radiation-induced cavernous hemangioma (RIOH) shows relatively thicker tumor walls (A) compared with conventional radiation therapy–induced RIOH (B) (Masson’s trichrome).

Reference

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