Das Kuntal Kanti, Singh Amanjot, Khatri Deepak, Gosal Jaskaran Singh, Bhaisora Kamlesh, Mehrotra Anant, Gogoi Sudarsana, Behari Sanjay
Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
Department of Neurosurgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.
Asian J Neurosurg. 2021 Mar 20;16(1):72-77. doi: 10.4103/ajns.AJNS_458_20. eCollection 2021 Jan-Mar.
Multifocality and metastasis from insular glioma are extremely rare. Pathological insights and elaboration of the clinical course of this condition will contribute to their better understanding.
Among 123 consecutively operated insular gliomas, 5 patients (4.2%) presented with a multifocal tumor. The clinico-radiological, histo-molecular, and treatment outcomes were noted and compared with the unifocal insular glioma cohort.
Among the five patients, all were males and involved the right insular lobe. Three patients presented with synchronous tumors, while two patients developed metachronous multifocal tumors. The histology of the insular tumor was Grade I glioma in 1, Grade II astrocytoma with p53 mutation in 2, and anaplastic astrocytoma and glioblastoma in one patient each. Histological confirmation of the second lesion was performed in two patients, showing the same histology of the insular tumor. Interconnection between the tumors was apparent through cerebrospinal fluid pathways in four patients, while no such connection could be established in one patient. Barring the patient of Grade I glioma, the rest of the patients died within months of the diagnosis.
Multifocal insular glioma is rare and probably represents a biologically more aggressive tumor. Insular glioma that touches the ventricle appears a common denominator for multifocality. True multicentricity is rare. The prognosis in insular glioma with multifocality is poor in non-Grade I gliomas.
岛叶胶质瘤的多灶性和转移极为罕见。对这种疾病的病理认识和临床病程的阐述将有助于更好地理解它们。
在连续接受手术的123例岛叶胶质瘤患者中，5例（4.2%）表现为多灶性肿瘤。记录临床放射学、组织分子学和治疗结果，并与单灶性岛叶胶质瘤队列进行比较。
5例患者均为男性，均累及右侧岛叶。3例患者为同步肿瘤，2例患者发生异时性多灶性肿瘤。岛叶肿瘤的组织学类型为1例I级胶质瘤，2例p53突变的II级星形细胞瘤，1例间变性星形细胞瘤和1例胶质母细胞瘤。2例患者对第二个病变进行了组织学确认，显示与岛叶肿瘤组织学相同。4例患者通过脑脊液途径可见肿瘤之间有明显联系，1例患者未发现这种联系。除I级胶质瘤患者外，其余患者在诊断后数月内死亡。
多灶性岛叶胶质瘤罕见，可能代表生物学行为更具侵袭性的肿瘤。累及脑室的岛叶胶质瘤似乎是多灶性的一个共同特征。真正的多中心性罕见。非I级岛叶胶质瘤多灶性的预后较差。
