Yao Kun, Wu Bin, Xi Mei, Duan Zejun, Wang Jiqiang, Qi Xueling
Department of Pathology, Beijing San Bo Brain Hospital, Capital Medical University Haidian District, Beijing, P. R. China.
Department of Neurosurgery, Beijing San Bo Brain Hospital, Capital Medical University Haidian District, Beijng, P. R. China.
Int J Clin Exp Pathol. 2015 Jun 1;8(6):7450-6. eCollection 2015.
We present a rare case of low-grade astroblastoma coexisting with an arteriovenous malformation (AVM) underwent surgery two times in a 38-year-old man. After the first surgery, this case was reported as a mixed low-grade astroblastoma and AVM. The lesion was completely resected surgically along with AVM. The patient underwent postoperative radiotherapy. Twenty months later, MRI showed enhanced lesions in suprasellar, pineal region and multiple small lesions in the spinal cord, whereas completely no recurrent lesion at the primary tumor site. So, the patient rationally underwent surgical removal in suprasellar and pineal region. After the second surgery, this case was diagnosed as a high-grade astroblastoma. Cells from the second surgical specimens showed high MIB-1 index and an increased olig-2 index. In addition, it is not common for low-grade astroblastoma metastasis to suprasellar, pineal region and spine with completely no recurrence at the original primary tumor site. Therefore it is difficult to predict tumor behavior and patient's clinical outcome merely based on histologic features. The important issue is whether the AVM was thought to be the cause of poor progress of this tumor. More cases are needed to confirm this. Classification and histogenesis of this tumor is still debated. Lack of clinicopathological correlation makes the prognosis of this tumor unpredictable. Anyway, we should be very discreet to treat the astroblastoma, even for low-grade astroblastoma.
我们报告了一例罕见的低级别成星形细胞瘤与动静脉畸形(AVM)并存的病例,该病例发生在一名38岁男性身上,其接受了两次手术。第一次手术后,该病例被报告为混合性低级别成星形细胞瘤和AVM。病变连同AVM一起被手术完全切除。患者接受了术后放疗。20个月后,MRI显示鞍上、松果体区有强化病变,脊髓有多个小病变,而原发肿瘤部位完全没有复发病变。因此,患者合理地接受了鞍上和松果体区的手术切除。第二次手术后,该病例被诊断为高级别成星形细胞瘤。第二次手术标本的细胞显示高MIB-1指数和olig-2指数增加。此外,低级别成星形细胞瘤转移至鞍上、松果体区和脊柱且原发肿瘤部位完全无复发并不常见。因此,仅根据组织学特征很难预测肿瘤行为和患者的临床结局。重要的问题是AVM是否被认为是该肿瘤进展不佳的原因。需要更多病例来证实这一点。该肿瘤的分类和组织发生仍存在争议。缺乏临床病理相关性使得该肿瘤的预后难以预测。无论如何,对于成星形细胞瘤的治疗,即使是低级别成星形细胞瘤,我们也应该非常谨慎。