Takamine Yusuke, Yamamuro Shun, Sumi Koichiro, Ohta Takashi, Shijo Katsunori, Nakanishi Yoko, Homma Taku, Yoshino Atsuo
Department of Neurological Surgery, Nihon University School of Medicine, Tokyo, Japan.
Division of Oncologic Pathology, Department of Pathology and Microbiology, Nihon University School of Medicine, Tokyo, Japan.
NMC Case Rep J. 2018 Dec 18;6(1):39-42. doi: 10.2176/nmccrj.cr.2018-0174. eCollection 2019 Jan.
Intracranial hemorrhage associated with lower grade glioma is unusual. Furthermore, pleomorphic xanthoastrocytoma (PXA) with intracranial hemorrhage, especially in a children, is extremely rare. We report here a rare case of child PXA with intracranial hemorrhage. An 11-year-old girl was admitted with headache and convulsions. A computed tomography scan demonstrated intracranial hemorrhage in the right temporal lobe. An angiogram revealed no vascular disease including arteriovenous malformation, angioma or aneurysm. Magnetic resonance (MR) imaging demonstrated no enhanced or cystic mass to suggest tumor presence. A follow-up study by MR imaging at 6 months after onset of the intracranial hemorrhage revealed a cystic mass lesion, with gadolinium-enhancement, in the right temporal lobe. This mass lesion was removed by surgery and diagnosed as PXA. Areas of tumor lesion could not be diagnosed immediately after the intracranial hemorrhage since bleeding lesion was prominent. Lower grade gliomas, including PXAs, should therefore be taken into consideration in the differential diagnosis of pediatric intracranial hemorrhage cases, separately from vascular disease and/or malignant brain tumor.
与低级别胶质瘤相关的颅内出血并不常见。此外，伴有颅内出血的多形性黄色星形细胞瘤（PXA），尤其是在儿童中，极为罕见。我们在此报告一例罕见的儿童PXA伴颅内出血病例。一名11岁女孩因头痛和惊厥入院。计算机断层扫描显示右侧颞叶有颅内出血。血管造影显示没有包括动静脉畸形、血管瘤或动脉瘤在内的血管疾病。磁共振（MR）成像未显示提示肿瘤存在的强化或囊性肿块。颅内出血发作6个月后的MR成像随访研究显示，右侧颞叶有一个囊性肿块病变，钆增强。该肿块病变通过手术切除并诊断为PXA。由于出血病变突出，颅内出血后肿瘤病变区域无法立即诊断。因此，在小儿颅内出血病例的鉴别诊断中，应将包括PXA在内的低级别胶质瘤与血管疾病和/或恶性脑肿瘤区分开来考虑。
