Tate Matthew C, Banerjee Anurahda, Vandenberg Scott R, Tihan Tarik, Chi John H, Ames Christopher P, Parsa Andrew T
Departments of Neurological Surgery, University of California San Francisco, California, USA.
J Neurosurg Pediatr. 2009 Nov;4(5):479-83. doi: 10.3171/2009.6.PEDS09266.
This 18-year-old woman presented with headache and diplopia over several months and was found to have an enhancing pineal tumor with resultant obstructive hydrocephalus. Following standard preoperative diagnostic tests, including spinal axis imaging, the patient was taken to the operating room for an endoscopic third ventriculostomy to relieve hydrocephalus and then subsequently underwent a craniotomy for gross-total resection of the pineal mass. The patient was discharged after an uneventful hospital course and received standard adjuvant cranial-spinal radiation and chemotherapy as an outpatient. Follow-up imaging 1 year after surgery demonstrated a metabolically active, lytic lesion in the C-3 vertebral body and new lung lesions suggesting a metastatic pineoblastoma. The patient underwent a C-3 anterior corpectomy and reconstruction without complication as aggressive therapy for presumed metastatic disease. Final pathological results from the vertebral lesion were consistent with radiation-induced reactive changes, not metastatic pineoblastoma as originally suspected. The patient recovered well and remains symptom free. To the authors' knowledge this is the first reported case of reactive changes mimicking metastasis in a single vertebral body following standard therapy for resected primary pineoblastoma.
这位18岁女性数月来一直有头痛和复视症状，经检查发现松果体区有一强化肿瘤，并导致梗阻性脑积水。在进行包括脊柱轴位成像在内的标准术前诊断检查后，患者被送往手术室接受内镜下第三脑室造瘘术以缓解脑积水，随后接受开颅手术，将松果体肿物进行大体全切。患者在经历平稳的住院过程后出院，并作为门诊患者接受了标准的辅助性颅脊髓放疗和化疗。术后1年的随访影像显示，C3椎体有一个代谢活跃的溶骨性病变以及新出现的肺部病变，提示松果体母细胞瘤转移。患者接受了C3椎体前路椎体切除及重建手术，未出现并发症，作为对疑似转移性疾病的积极治疗。椎体病变的最终病理结果与放射性诱导的反应性改变相符，而非最初怀疑的转移性松果体母细胞瘤。患者恢复良好，至今无症状。据作者所知，这是首例报道的在切除原发性松果体母细胞瘤的标准治疗后，单个椎体出现类似转移的反应性改变的病例。
