Kaji Masatomo, Takeshima Hideo, Nakazato Yoichi, Kuratsu Jun-ichi
Department of Neurosurgery, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan.
Neurol Med Chir (Tokyo). 2006 Sep;46(9):450-4. doi: 10.2176/nmc.46.450.
A 17-year-old male presented with morning headache and double vision. Neuroimaging revealed a lobulated enhanced mass lesion with a blurred margin and remarkable peritumoral edema, and high uptake of methionine. The gray, soft, well-circumscribed mass was grossly totally resected. Histological examination showed the tumor cells were well differentiated with the perivascular pseudorosette pattern with broad, non-tapering processes radiating towards a central vessel without anaplastic features such as necrosis and endothelial proliferation. The histological diagnosis was low-grade astroblastoma. Follow-up magnetic resonance imaging demonstrated local recurrence 5 months later. Second surgery was followed by adjuvant radiotherapy and combination chemotherapy. Histological examination disclosed wide invasion by tumor cells into the subpial and perivascular space of the surrounding brain tissue. Follow-up magnetic resonance imaging demonstrated further recurrence around the tumor cavity. Surgical removal followed by six courses of combination chemotherapy (ifosfamide, cisplatin, and etoposide) resulted in complete remission of the tumor. Although gross total resection of astroblastoma usually results in long-term survival, some of these yet unfamiliar tumors may develop a more malignant character.
一名17岁男性出现晨起头痛和复视症状。神经影像学检查显示有一个分叶状强化肿块病变，边界模糊，瘤周水肿明显，且甲硫氨酸摄取量高。灰白色、质地柔软、边界清晰的肿块被完整切除。组织学检查显示肿瘤细胞分化良好，呈血管周围假菊形团模式，有宽阔、无逐渐变细的突起向中央血管放射状延伸，无坏死和内皮细胞增生等间变特征。组织学诊断为低级别成星形细胞瘤。随访磁共振成像显示5个月后局部复发。二次手术后进行了辅助放疗和联合化疗。组织学检查发现肿瘤细胞广泛侵入周围脑组织的软膜下和血管周围间隙。随访磁共振成像显示肿瘤腔周围进一步复发。手术切除后进行六个疗程的联合化疗（异环磷酰胺、顺铂和依托泊苷）使肿瘤完全缓解。虽然成星形细胞瘤的完整切除通常可实现长期生存，但其中一些尚不为人熟知的肿瘤可能会发展出更具恶性的特征。
