Kano Tomoaki, Ikota Hayato, Wada Hirochiyo, Iwasa Susumu, Kurosaki Shuhei
Department of Neurosurgery, Fukaya Red Cross Hospital, 5-8-1 Kamishibanishi, Fukaya, Saitama 366-0052, Japan.
Brain Tumor Pathol. 2009;26(1):11-7. doi: 10.1007/s10014-008-0240-x. Epub 2009 Apr 30.
A 29-year-old woman presented with a severe headache. Computed tomography revealed a large cystic lesion with a mural nodule-like mass homogeneously enhanced with contrast medium in the right cerebellum. The tumor was removed, and pathological studies revealed a cerebellar astrocytoma corresponding to World Health Organization grade II. When she was 35 years old, or 6 years after the surgery, magnetic resonance imaging revealed a recurrence of the tumor in the right cerebellum, and subtotal removal of the recurrent tumor was performed. Pathological studies revealed a mixed glioblastoma multiforme and anaplastic ependymoma. Chemotherapy (Paraplatin and VePeside-S) and focal radiation therapy at 60 Gy were administered following surgery. Thereafter, at 39 years of age, or 4 years after radiation therapy, magnetic resonance imaging again revealed a recurrence of the tumor, which was heterogeneously enhanced with gadoliniumdiethylenetriamine pentaacetic acid in the right cerebellum. Subtotal removal of the tumor was performed; pathological studies revealed an anaplastic ependymoma with sarcomatous components. Immunohistochemical findings showed some parts of the sarcomatous components to stain positively for glial fibrillary acidic protein and, as a result, these sarcomatous components were diagnosed to be gliosarcoma.
一名29岁女性因严重头痛就诊。计算机断层扫描显示右侧小脑有一个大的囊性病变，伴有一个壁结节样肿块，增强扫描后呈均匀强化。肿瘤被切除，病理研究显示为符合世界卫生组织二级的小脑星形细胞瘤。她35岁时，即手术后6年，磁共振成像显示右侧小脑肿瘤复发，遂对复发肿瘤进行了次全切除。病理研究显示为多形性胶质母细胞瘤和间变性室管膜瘤混合型。术后给予化疗（顺铂和依托泊苷）及60 Gy的局部放射治疗。此后，39岁时，即放疗后4年，磁共振成像再次显示右侧小脑肿瘤复发，钆喷酸葡胺增强扫描呈不均匀强化。对肿瘤进行了次全切除；病理研究显示为具有肉瘤成分的间变性室管膜瘤。免疫组织化学结果显示肉瘤成分的某些部分胶质纤维酸性蛋白染色呈阳性，因此，这些肉瘤成分被诊断为胶质肉瘤。
