Tsuboi Yoshifumi, Kurimoto Masanori, Nagai Shoichi, Kamiyama Hironaga, Endo Shunro
Department of Neurosurgery, University of Toyama, 2630 Sugitani, Toyama 930-0194, Japan.
Brain Tumor Pathol. 2007;24(2):63-8. doi: 10.1007/s10014-007-0217-1. Epub 2007 Nov 28.
We report a case of oligoastrocytoma resembling dysembryoplastic neuroepithelial tumor (DNT) with malignant transformation. A 35-year-old woman presented with headache and generalized convulsion in May 2003. Magnetic resonance imaging (MRI) revealed an extensive left temporal lobe tumor. She underwent partial resection of the tumor under awake surgery, while preserving her language function. The surgical specimen showed that the majority of the tumor was composed of a glioneuronal element. However, there was also an abundant oligoastrocytoma component. Therefore, our first pathological diagnosis was oligoastrocytoma and DNT. She then underwent radiation therapy. The tumor recurred at the left temporal lobe in June 2005. She then underwent open biopsy. The pathological diagnosis was anaplastic oligoastrocytoma with a MIB-1 staining index of 79%. She received PAV (procarvazine, ACNU, and vincristine) chemotherapy, and the tumor subsided transiently. However, she died 3 years after the first operation. Although the histological findings of the first surgical specimen closely resembled those of DNT, radiologic findings and clinical course were different from those of DNT. The authors concluded that this tumor could be a malignant transformation of oligoastrocytoma mimicking DNT, and we wish to give warning that the presence of a glioneuronal component is not an absolute benign hallmark.
我们报告一例类似于胚胎发育不良性神经上皮肿瘤（DNT）并发生恶性转化的少突星形细胞瘤。一名35岁女性于2003年5月出现头痛和全身性惊厥。磁共振成像（MRI）显示左侧颞叶有一个广泛的肿瘤。她在清醒手术下行肿瘤部分切除术，同时保留其语言功能。手术标本显示肿瘤大部分由神经胶质神经元成分组成。然而，也有丰富的少突星形细胞瘤成分。因此，我们最初的病理诊断为少突星形细胞瘤和DNT。随后她接受了放射治疗。2005年6月肿瘤在左侧颞叶复发。她随后接受了开放性活检。病理诊断为间变性少突星形细胞瘤，MIB - 1染色指数为79%。她接受了PAV（丙卡巴肼、阿糖胞苷和长春新碱）化疗，肿瘤暂时消退。然而，她在首次手术后3年死亡。尽管首次手术标本的组织学表现与DNT非常相似，但影像学表现和临床病程与DNT不同。作者得出结论，该肿瘤可能是少突星形细胞瘤模仿DNT发生的恶性转化，我们希望提醒注意神经胶质神经元成分的存在并非绝对的良性标志。
