Jie Weiping, Bai Jiaying, Li Binbin
Department of Oral Pathology, Peking University School and Hospital of Stomatology, Beijing, PR China; National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing, PR China.
Department of Oral Pathology, Peking University School and Hospital of Stomatology, Beijing, PR China; Beijing Key Laboratory of Digital Stomatology, Beijing, PR China.
World Neurosurg. 2018 Aug;116:352-356. doi: 10.1016/j.wneu.2018.05.132. Epub 2018 May 28.
Glioblastoma (GBM) is the most common and aggressive primary malignant tumor of the brain and central nervous system. Extracranial metastases of GBM are rare, with few case reports published to date. The tumor cells of GBM show strong immunopositivity for glial fibrillary acid protein.
A 47-year-old man without comorbidities presented with a 1-year history of an augmenting right parotid lump. A right total parotidectomy with selective neck dissection was performed. The hematoxylin-eosin-stained slice of a parotid lymph node collected intraoperatively revealed destruction of normal lymph node structure by medium-sized pleomorphic cells scattered in groups; their cytoplasm was lightly stained and pale. There were abundant myxoid stroma in the interstitial tissue. This characteristic mimicked mucoepidermoid carcinoma. An immunohistochemistry test demonstrated that the tumor cells were positive for glial fibrillary acid protein. A diagnosis of extracranial metastasis of GBM was made after confirmation with postoperative pathologic examination and the review of the intracranial resection specimen.
We believe that this is the first reported case of extracranial metastasis of GBM resembling mucoepidermoid carcinoma in the microscope features. Pathologists and clinicians should be alert to this rare lesion and consider this differential diagnosis after excluding other common parotid lesions.
胶质母细胞瘤(GBM)是脑和中枢神经系统最常见且侵袭性最强的原发性恶性肿瘤。GBM的颅外转移罕见,迄今为止发表的病例报告很少。GBM的肿瘤细胞对胶质纤维酸性蛋白显示出强免疫阳性。
一名47岁无合并症男性,有右侧腮腺肿块增大1年病史。行右侧腮腺全切除术并选择性颈清扫术。术中采集的腮腺淋巴结苏木精-伊红染色切片显示,正常淋巴结结构被散在成群的中等大小多形性细胞破坏;其细胞质淡染且苍白。间质组织中有丰富的黏液样基质。此特征类似黏液表皮样癌。免疫组织化学检测显示肿瘤细胞胶质纤维酸性蛋白阳性。经术后病理检查及颅内切除标本复查确诊为GBM颅外转移。
我们认为这是首例在显微镜特征上类似黏液表皮样癌的GBM颅外转移病例报告。病理学家和临床医生应警惕这种罕见病变,并在排除其他常见腮腺病变后考虑这种鉴别诊断。