Department of Neurosurgery, Institute of Psychiatry and Neurology, Warsaw, Poland.
2nd Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland.
Folia Neuropathol. 2022;60(2):250-256. doi: 10.5114/fn.2022.117267.
Glioblastoma (GBM) is the most malignant type of glial tumor associated with a very unfavorable prognosis. Typical radiological features of GBM include the presence of a tumor with irregular contrast-enhancing margins and central necrosis surrounded by a wide area of vasogenic edema. Here, we presented an atypical clinical presentation of GBM mimicking autoimmune meningitis. A 69-years-old previously healthy male was admitted to the emergency room due to signs of increasing cognitive impairment, weight loss, changes in behavior, difficulty in walking, and prolonged episodes of nausea over the past month. An magnetic resonance imaging (MRI) brain scan revealed hyperintense changes of the periventricular area surrounding brain ventricles in T2 and FLAIR, and post-contrast leptomeningeal enhancement and thickening of meninges involving cerebellar sulci. An additional MRI scan of the cervical spine showed an in-core contrastenhancing lesion on the C7-Th1 level as well as leptomeningeal thickening and post-contrast-enhancement around the spinal cord. Various laboratory tests and two stereotactic biopsies were performed with no essential to diagnosis clinical findings. A couple of months after first hospital admission, the patient died. Post-mortem examination of the brain revealed numerous foci of abnormal tissue inside the subarachnoid space, lateral ventricles, and cerebral aqueduct. Histological examination showed diffuse malignant astroglial neoplasm, and diagnosis of glioblastoma NOS WHO G IV was established. Even though the appearance of usual GBM is widely recognizable, one must bear in mind the possibility of unusual presentation. The presented case highlights the diagnostic difficulties of diffuse glioblastoma with atypical clinical presentation.
胶质母细胞瘤（GBM）是最恶性的神经胶质瘤，预后非常差。GBM 的典型影像学特征包括肿瘤具有不规则的对比增强边缘和中央坏死，周围有广泛的血管源性水肿区。在这里，我们报告了一例表现不典型的 GBM 病例，类似于自身免疫性脑膜炎。一名 69 岁的既往健康男性因认知障碍加重、体重减轻、行为改变、行走困难和长时间恶心等症状而被收入急诊室。头部磁共振成像（MRI）扫描显示脑室周围区域 T2 和 FLAIR 呈高信号改变，软脑膜脑膜增强和增厚累及小脑沟。颈椎 MRI 扫描显示 C7-Th1 水平的核心对比增强病变以及脊髓周围的软脑膜增厚和对比增强。进行了各种实验室检查和两次立体定向活检，但没有明确的诊断结果。首次住院治疗几个月后，患者死亡。大脑尸检显示蛛网膜下腔、侧脑室和脑导水管内有许多异常组织病灶。组织学检查显示弥漫性恶性星形胶质细胞瘤，诊断为胶质母细胞瘤NOS WHO G IV。尽管通常的 GBM 表现广泛可识别，但必须牢记不典型表现的可能性。所报告的病例强调了具有不典型临床表现的弥漫性胶质母细胞瘤的诊断困难。
