Funata Nobuaki, Nobusawa Sumihito, Yamada Ryoji, Shinoura Nobusada
Department of Pathology, Cancer and Infectious Disease Center Tokyo Metropolitan Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan.
Department of Human Pathology, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, Japan.
Brain Tumor Pathol. 2016 Jan;33(1):57-62. doi: 10.1007/s10014-015-0239-z. Epub 2015 Nov 24.
Epithelioid glioblastomas (E-GBMs) are rare, highly aggressive tumors consisting of closely packed tumor cells with smooth, round cell borders and abundant eosinophilic cytoplasm. They tend to affect younger patients compared with conventional GBM. BRAF V600E mutation is characteristically found in approximately 50% of all E-GBMs, compared with a low frequency of this mutation in conventional GBM. Here, we report an unusual case of glioma involving the right frontal lobe, basal ganglia and thalamus in an HIV-positive 30-year-old man on antiretroviral therapy. The lesion was composed of abundant discohesive, monotonous epithelioid cells with extensive necrosis, spindle and polyhedral cells, low-grade oligoastrocytoma-like areas, sarcomatous components, and numerous osteoclast-like giant cells (OLGCs) intermingled with epithelioid tumor cells. As the epithelioid cells accounted for more than one-third of the tumor, a pathological diagnosis of E-GBM was made. BRAF V600E mutation was detected in both oligoastrocytoma-like and epithelioid cell components. Similar to previously reported findings on E-GBM associated with low-grade glioma, this case suggested that low-grade astrocytic glioma with BRAF V600E mutation progressed to E-GBM. OLGCs are rarely observed in gliomas, and this is the first case report of E-GBM associated with abundant OLGC infiltration.
上皮样胶质母细胞瘤(E-GBM)是一种罕见的、高度侵袭性肿瘤,由紧密排列的肿瘤细胞组成,细胞边界光滑、呈圆形,细胞质嗜酸性丰富。与传统的胶质母细胞瘤相比,它们往往影响更年轻的患者。BRAF V600E突变在所有E-GBM中约50%有特征性发现,而在传统胶质母细胞瘤中该突变频率较低。在此,我们报告一例不寻常的胶质瘤病例,发生在一名接受抗逆转录病毒治疗的30岁HIV阳性男性的右侧额叶、基底神经节和丘脑。病变由大量分散、单一的上皮样细胞组成,伴有广泛坏死、梭形和多面体细胞、低级别少突星形细胞瘤样区域、肉瘤样成分,以及许多与上皮样肿瘤细胞混合的破骨细胞样巨细胞(OLGC)。由于上皮样细胞占肿瘤的三分之一以上,故作出E-GBM的病理诊断。在少突星形细胞瘤样和上皮样细胞成分中均检测到BRAF V600E突变。与先前报道的与低级别胶质瘤相关的E-GBM的发现相似,该病例提示伴有BRAF V600E突变的低级别星形细胞胶质瘤进展为E-GBM。OLGC在胶质瘤中很少见,这是首例与大量OLGC浸润相关的E-GBM病例报告。