Lober Robert, Sharma Suash, Bell Beverly, Free Alan, Figueroa Ramon, Sheils Chris W, Lee Mark, Cowell John
Departments of Pathology.
Rare Tumors. 2010 Sep 30;2(3):e48. doi: 10.4081/rt.2010.e48.
Spinal cord tumors in pediatric patients are rare, representing less than 1% of all central nervous system tumors. Two cases of pediatric primary intramedullary spinal cord glioblastoma at ages 14 and 8 years are reported. Both patients presented with rapid onset paraparesis and quadraparesis. Magnetic resonance imaging in both showed heterogeneously enhancing solitary mass lesions localized to lower cervical and upper thoracic spinal cord parenchyma. Histopathologic diagnosis was glioblastoma. Case #1 had a small cell component (primitive neuroectodermal tumor-like areas), higher Ki67, and p53 labeling indices, and a relatively stable karyotype with only minimal single copy losses involving regions: Chr8;pter-30480019, Chr16;pter-29754532, Chr16;56160245-88668979, and Chr19;32848902-qter on retrospective comparative genomic hybridization using formalin-fixed, paraffin-embedded samples. Case #2 had relatively bland histomorphology and negligible p53 immunoreactivity. Both underwent multimodal therapy including gross total resection, postoperative radiation and chemotherapy. However, there was no significant improvement in neurological deficits, and overall survival in both cases was 14 months.This report highlights the broad histological spectrum and poor overall survival despite multi modality therapy. The finding of relatively unique genotypic abnormalities resembling pediatric embryonal tumors in one case may highlight the value of genome-wide profiling in development of effective therapy. The differences in management with intracranial and low-grade spinal cord gliomas and current management issues are discussed.
小儿脊髓肿瘤较为罕见,占所有中枢神经系统肿瘤的比例不到1%。本文报告了2例分别为14岁和8岁的小儿原发性髓内脊髓胶质母细胞瘤病例。两名患者均表现为快速发作的截瘫和四肢瘫。两人的磁共振成像均显示在颈下段和胸上段脊髓实质内有不均匀强化的孤立性肿块病变。组织病理学诊断为胶质母细胞瘤。病例1有一个小细胞成分(原始神经外胚层肿瘤样区域),Ki67和p53标记指数较高,并且在使用福尔马林固定、石蜡包埋样本进行的回顾性比较基因组杂交中,其核型相对稳定,仅涉及以下区域有极小的单拷贝缺失:Chr8;pter - 30480019、Chr16;pter - 29754532、Chr16;56160245 - 88668979以及Chr19;32848902 - qter。病例2的组织形态学相对平淡,p53免疫反应性可忽略不计。两人均接受了多模式治疗,包括全切除、术后放疗和化疗。然而,神经功能缺损并无显著改善,两例患者的总生存期均为14个月。本报告强调了尽管采用了多模式治疗,但组织学谱广泛且总生存期较差。在其中一例中发现了类似于小儿胚胎性肿瘤的相对独特的基因型异常,这可能凸显了全基因组分析在有效治疗方案制定中的价值。文中还讨论了颅内和低级别脊髓胶质瘤治疗方法的差异以及当前的治疗问题。