Neurosurgery Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
World Neurosurg. 2011 Jan;75(1):126-31; discussion 50-3. doi: 10.1016/j.wneu.2010.09.014.
The coexistence of a primary brain tumor such as high-grade glioma and superimposed abscess is a rare entity and can present a diagnostic and therapeutic challenge. The concomitant abscess may not be recognized until surgery, and the overall course of treatment may require adjustment in the presence of a coinciding infection. In the present report we evaluate the diagnosis and treatment of a glioblastoma multiforme with an intratumoral abscess.
A patient was diagnosed with a glioblastoma multiforme with a concomitantly superimposed multimicrobial abscess containing coagulase-negative Staphylococcus, Acinetobacter iwofii, and Propionibacterium species. The suspected infectious source was a dental abscess with presumed secondary seeding. The patient underwent a left anterior temporal lobectomy with debulking of the lesion. Although the adjuvant therapy schedule was adjusted to accommodate the course of antibiotics, the existence of a concurrent abscess did not preclude adjuvant radiation and chemotherapy.
The patient responded well to antibiotic treatment with no evidence of recurrent infection. He underwent a second operation for additional debulking of the lesion approximately half a year after his initial surgery. The patient died 2 years after the initial diagnosis.
There are insufficient guidelines on the treatment of a primary brain tumor with intratumoral abscess. In this report we present our therapeutic decisions in this rare case.
原发性脑瘤（如高级别胶质瘤）合并脓肿是一种罕见的疾病，会给诊断和治疗带来挑战。在手术时可能才会发现并存的脓肿，而在合并感染的情况下，整体治疗过程可能需要调整。本报告评估了伴发脑内脓肿的多形性胶质母细胞瘤的诊断和治疗。
一名患者被诊断为多形性胶质母细胞瘤，同时合并有多微生物脓肿，其中包括凝固酶阴性葡萄球菌、琼氏不动杆菌和丙酸杆菌属。疑似感染源为牙脓肿，推测为继发性播散。患者接受了左前颞叶切除术和病变的去瘤手术。尽管辅助治疗方案因抗生素疗程而进行了调整，但并存脓肿并不妨碍辅助放疗和化疗。
患者对抗生素治疗反应良好，无复发性感染的证据。在初始手术后大约半年，他进行了第二次手术以进一步切除病变。患者在初始诊断后 2 年死亡。
针对伴发脑内脓肿的原发性脑瘤，目前尚无足够的治疗指南。本报告介绍了我们在这一罕见病例中的治疗决策。
