Lee Seung J, Kim Minsu, Lagman Carlito, Bui Timothy T, Yong William H, Yang Isaac
Department of Neurosurgery, University of California, Los Angeles, Los Angeles, California, USA.
Department of Neurosurgery, Yeungnam University College of Medicine, Daemyung-dong, Nam-gu, Daegu, Korea.
Surg Neurol Int. 2017 Apr 26;8:64. doi: 10.4103/sni.sni_423_16. eCollection 2017.
Corpora amylacea (CA) are accumulations of polyglucosan bodies typically found in astrocytic foot processes, and rarely, can mimic neoplasm. CA accumulation has also been associated with seizure disorders. We report the first case of a histologically confirmed intracranial, intraparenchymal CA lesion mimicking a low-grade glioma and manifesting as a seizure.
A 43-year-old man presented after a general tonic-clonic (GTC) seizure. Brain magnetic resonance imaging (MRI) revealed a small lesion in the right mesial temporal lobe with radiologic features of a low-grade glioma. The patient underwent a right pteronial craniotomy for resection of the lesion. Histology demonstrated abundant polyglucosan bodies without neoplastic features. The patient tolerated the procedure well, was free from seizures without antiepileptic drugs at 2-week follow-up, and is undergoing serial surveillance.
The clinical manifestation of CA as a seizure in the context of an identified brain mass is extraordinarily rare. Nevertheless, CA should be considered in the differential diagnosis for patients with seizures and a radiologically identifiable low-grade lesion. Symptomatic CA lesions Mimicking a low-grade glioma should be surgically pursued with a goal of safe, maximal resection to confirm the diagnosis and to provide the patient with prognosis, which can significantly impact patient quality of life.
淀粉样体(CA)是多葡聚糖体的聚积物,通常见于星形胶质细胞足突,极少数情况下可类似肿瘤。CA聚积也与癫痫发作障碍有关。我们报告首例经组织学证实的颅内、脑实质内CA病变,该病变类似低级别胶质瘤并表现为癫痫发作。
一名43岁男性在全身强直阵挛发作(GTC)后就诊。脑部磁共振成像(MRI)显示右侧颞叶内侧有一个小病变,具有低级别胶质瘤的影像学特征。患者接受了右翼点开颅手术以切除病变。组织学检查显示有大量多葡聚糖体,无肿瘤特征。患者对手术耐受良好,在2周随访时未服用抗癫痫药物即无癫痫发作,目前正在接受定期监测。
在已确定脑肿块的情况下,CA表现为癫痫发作极为罕见。然而,对于癫痫发作且有影像学可识别的低级别病变的患者,鉴别诊断时应考虑CA。对于类似低级别胶质瘤的有症状CA病变,应以安全、最大限度切除为目标进行手术,以确诊并为患者提供预后信息,这可能会显著影响患者的生活质量。