Mizuno Reina, Homma Taku, Adachi Jun-Ichi, Mishima Kazuhiko, Suzuki Tomonari, Shirahata Mitsuaki, Nishikawa Ryo, Atushi Sasaki
Departments of1Craniospinal Tumor and.
2Pathology, Saitama International Medical Center, Saitama, Japan; and.
J Neurosurg Case Lessons. 2022 Jul 18;4(3):CASE22146. doi: 10.3171/CASE22146.
The revised fourth edition of the World Health Organization classification of central nervous system tumors was published in 2016. Based on this classification, one of the infiltrating glioma entities named "oligoastrocytoma/anaplastic oligoastrocytoma" is discouraged. It is proposed that these mixed gliomas should be classified as diffuse astrocytoma/anaplastic astrocytoma or oligodendroglioma/anaplastic oligodendroglioma when analyzing their genetic alteration.
A 78-year-old female underwent brain computed tomography (CT) because of a traffic accident. Cranial CT revealed a brain tumor in the left temporoparietal lobe; therefore, she was hospitalized. She underwent awake craniotomy. After the operation, she was treated with only local radiotherapy; the authors could not prescribe temozolomide, because she had had levetiracetam-induced pancytopenia. The remaining tumor neuroradiologically disappeared, and she was alive 40 months after the operation without tumor recurrence.
Histopathologically, this tumor was diagnosed as an anaplastic oligoastrocytoma with a distinct dual phenotype of astrocytoma and oligodendroglioma components. Genetically, these two components revealed astrocytoma and oligodendroglioma genotypes, respectively. Therefore, the authors considered the integrated diagnosis of the temporal tumor as a true anaplastic oligoastrocytoma with a dual genotype. Interestingly, this case also included an area composed of spindle to oval neoplastic cells that revealed intermediate genetic alterations between astrocytomas and oligodendrogliomas.
世界卫生组织中枢神经系统肿瘤分类的修订第四版于2016年发布。基于此分类，不鼓励使用名为“少突星形细胞瘤/间变性少突星形细胞瘤”的浸润性胶质瘤实体。建议在分析这些混合性胶质瘤的基因改变时，应将其分类为弥漫性星形细胞瘤/间变性星形细胞瘤或少突胶质细胞瘤/间变性少突胶质细胞瘤。
一名78岁女性因交通事故接受脑部计算机断层扫描（CT）。头颅CT显示左颞顶叶有一个脑肿瘤；因此，她住院了。她接受了清醒开颅手术。术后，她仅接受了局部放疗；作者无法开具替莫唑胺，因为她曾因左乙拉西坦导致全血细胞减少。剩余肿瘤在神经影像学上消失，术后40个月她仍存活且无肿瘤复发。
组织病理学上，该肿瘤被诊断为具有明显星形细胞瘤和少突胶质细胞瘤成分双重表型的间变性少突星形细胞瘤。基因上，这两个成分分别显示出星形细胞瘤和少突胶质细胞瘤的基因型。因此，作者认为该颞叶肿瘤的综合诊断为具有双重基因型的真正间变性少突星形细胞瘤。有趣的是，该病例还包括一个由梭形至椭圆形肿瘤细胞组成的区域，其显示出星形细胞瘤和少突胶质细胞瘤之间的中间基因改变。
