Liu Lei, Wang Shaozhen, Dong Xuetao, Liu Yaodong, Wei Liudong, Kong Linghong, Zhang Qingjun, Zhang Kun
Department of Neurosurgery, Chui Yang Liu Hospital Affiliated to Tsinghua University, Beijing, China.
Department of Pathology, Chui Yang Liu Hospital Affiliated to Tsinghua University, Beijing, China.
Front Oncol. 2022 Sep 13;12:995189. doi: 10.3389/fonc.2022.995189. eCollection 2022.
Intraventricular glioblastoma multiforme (GBM) is extremely rare, especially in the trigone region. This report presents a case of trigone ventricular GBM with trapped temporal horn (TTH).
A 59-year-old woman was admitted to our department with a 1-month history of rapidly progressive headache, nausea, and weakness in the right lower extremity. Head non-contrast computed tomography and enhanced magnetic resonance imaging (MRI) revealed a trigone ventricular mass lesion with TTH and heterogeneous enhancement. The lesion was found 18 months ago as a small asymptomatic tumor mimicking ependymoma. This neoplasm was removed subtotally through the right parieto-occipital approach guided by neuroendoscopy. A ventriculoperitoneal shunt was subsequently performed to relieve TTH. The final pathological diagnosis was GBM. Unfortunately, 36 days after the first surgery, the patient died due to her family's decision to refuse therapy.
This rare case shows that GBM should be considered in the differential diagnosis of trigonal tumors. In this case, the tumor possibly originated from the neural stem cells in the subventricular zone. Patients with intraventricular GBM have a worse prognosis, and careful follow-up and early surgery for small intraventricular tumors are necessary, even for those with ependymoma-like radiological findings.
脑室内多形性胶质母细胞瘤(GBM)极为罕见,尤其是在三角区。本报告介绍了一例伴有颞角受压(TTH)的三角区脑室内GBM病例。
一名59岁女性因1个月来迅速进展的头痛、恶心及右下肢无力入院。头颅非增强计算机断层扫描和增强磁共振成像(MRI)显示一个伴有TTH和不均匀强化的三角区脑室内肿块病变。该病变18个月前被发现为一个无症状的小肿瘤,类似室管膜瘤。通过神经内镜引导下的右顶枕入路,次全切除了该肿瘤。随后进行了脑室腹腔分流术以缓解TTH。最终病理诊断为GBM。不幸的是,首次手术后36天,患者因家属拒绝治疗而死亡。
这个罕见病例表明,在三角区肿瘤的鉴别诊断中应考虑GBM。在本病例中,肿瘤可能起源于脑室下区的神经干细胞。脑室内GBM患者预后较差,对于小的脑室内肿瘤,即使具有类似室管膜瘤的影像学表现,也需要仔细随访并尽早手术。