Alam Yasaman, Mugge Luke A, Purdy Jenna, Mrak Robert E, Schroeder Jason
Neurosurgery, University of Toledo School of Medicine, Toledo, USA.
Surgery/Neurosurgery, University of Toledo Medical Center, Toledo, USA.
Cureus. 2018 Sep 10;10(9):e3272. doi: 10.7759/cureus.3272.
Glioblastoma multiforme (GBM) is a World Health Organization (WHO) grade IV primary malignant astrocytoma. Aneurysms are devastating intracranial neurovascular pathologies. Intracranial dermoid cysts are common, benign lesions which can be clinically silent or associated with seizure disorder. We describe physically adjacent diagnoses of dermoid cyst, intracranial aneurysm, and GBM in a single patient. Records were collected and reviewed to compile the final clinical picture. A 72-year-old male with a long history of seizure disorder, presented with new focal, unilateral neurological deficits. Radiographic evaluation including computed tomography (CT) and magnetic resonance imaging (MRI) demonstrated a dermoid cyst with an underlying developing GBM, which also, by happenstance, contained an aneurysm. During open surgical resection, multiple macroscopically distinct tissue types were noted. Histological analysis of tissue from each lesion confirmed the diagnoses including dermoid cyst, GBM, and aneurysm. Pathological analysis revealed the presence of extensive inflammatory cells throughout. Subsequent staining identified CD68 positive cells indicating a probable chronic inflammatory state. Chronic inflammation resulting from the presence of a long term dermoid cyst and ongoing seizures may have led to dystrophic changes in adjacent vasculature and approximating glial tissues, inducing the formation of an aneurysm and a secondary GBM. Therefore, while benign in nature, dermoid cysts can be related to seizure disorder and may cause chronic inflammation in surrounding brain tissue.
多形性胶质母细胞瘤（GBM）是世界卫生组织（WHO）IV级原发性恶性星形细胞瘤。动脉瘤是毁灭性的颅内神经血管病变。颅内皮样囊肿是常见的良性病变，临床上可能无症状或与癫痫发作有关。我们描述了一名患者同时出现皮样囊肿、颅内动脉瘤和GBM的物理相邻诊断情况。收集并审查记录以汇总最终临床表现。一名有长期癫痫发作病史的72岁男性，出现新的局灶性、单侧神经功能缺损。包括计算机断层扫描（CT）和磁共振成像（MRI）在内的影像学评估显示一个皮样囊肿，其下方有一个正在发展的GBM，偶然的是，该囊肿还含有一个动脉瘤。在开放性手术切除过程中，注意到多种宏观上不同的组织类型。对每个病变组织的组织学分析证实了诊断，包括皮样囊肿、GBM和动脉瘤。病理分析显示各处均存在大量炎性细胞。随后的染色鉴定出CD68阳性细胞，表明可能处于慢性炎症状态。长期存在的皮样囊肿和持续的癫痫发作导致的慢性炎症可能导致相邻血管系统和邻近神经胶质组织发生营养不良性改变，诱发动脉瘤和继发性GBM的形成。因此，虽然皮样囊肿本质上是良性的，但可能与癫痫发作有关，并可能导致周围脑组织的慢性炎症。
