Kojima Kazuhiro, Arakawa Yoshiki, Takeuchi Yasuhide, Terada Yukinori, Tanji Masahiro, Mineharu Yohei, Haga Hironori, Miyamoto Susumu
Departments of1Neurosurgery and.
2Diagnostic Pathology, Kyoto University Graduate School of Medicine, Kyoto, Japan.
J Neurosurg Case Lessons. 2022 Feb 7;3(6). doi: 10.3171/CASE21610.
Central neurocytomas usually have a favorable clinical course, and gross total resection (GTR) results in long-term survival. Recurrences of central neurocytomas are usually local, and dissemination is extremely rare.
A 24-year-old man who presented with vomiting was found to have a mass in the right lateral ventricle. After GTR, he received whole-brain irradiation and chemotherapy and had remained disease-free on follow-up for years. The review of the initial tumor revealed central neurocytoma. Seventeen years later, he presented with deterioration of memory, and magnetic resonance imaging showed an enhanced lesion in the left hippocampus. The enhanced lesion was resected, and the histological examination revealed that the tumor was a disseminated atypical central neurocytoma with frequent mitoses. Although he was treated with chemotherapy, the disseminated tumor slowly grew and invaded the brain. Massive brain invasion occurred without enhanced lesions, and he died 27 months after the tumor recurrence.
In this patient, a central neurocytoma disseminated after an extremely long period of time. Once neurocytomas disseminate and show aggressive behavior, patients usually follow a poor course. Patients with central neurocytomas should be followed up for a long time.
中枢神经细胞瘤通常具有良好的临床病程，全切除可实现长期生存。中枢神经细胞瘤复发通常为局部复发，播散极为罕见。
一名24岁男性因呕吐就诊，发现右侧脑室有一肿块。全切除术后，他接受了全脑放疗和化疗，随访多年无疾病复发。最初肿瘤的检查显示为中枢神经细胞瘤。17年后，他出现记忆力减退，磁共振成像显示左侧海马区有一强化病灶。该强化病灶被切除，组织学检查显示肿瘤为播散性非典型中枢神经细胞瘤，有频繁的核分裂象。尽管他接受了化疗，但播散性肿瘤仍缓慢生长并侵犯脑部。在无强化病灶的情况下发生了广泛的脑侵犯，肿瘤复发27个月后他死亡。
在该患者中，中枢神经细胞瘤在极长一段时间后发生了播散。一旦神经细胞瘤发生播散并表现出侵袭性行为，患者的病程通常较差。中枢神经细胞瘤患者应进行长期随访。
