Consoli Stefano, Dono Fedele, Evangelista Giacomo, Corniello Clarissa, Onofrj Marco, Thomas Astrid, Sensi Stefano L
Department of Neuroscience, Imaging and Clinical Science, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy.
Epilepsy Center, "SS Annunziata" Hospital, Chieti, Italy.
Front Oncol. 2023 Aug 24;13:1254674. doi: 10.3389/fonc.2023.1254674. eCollection 2023.
Glioblastoma (GBM) is the most common primary brain tumor in adulthood. Initial diagnosis is generally based on clinical and MRI findings, which may be misinterpreted as other neurological pictures, including autoimmune encephalitis (AE). AE is a heterogeneous group of neuroinflammatory diseases due to the presence of auto-antibodies targeting antigens on neuronal synaptic or cell surface. In the present report, we describe two peculiar cases of GBM initially misdiagnosed as AE, focusing on the diagnostic pitfalls and the treatment strategies.
We report the case of two patients with high-grade brain tumors, initially misdiagnosed and treated for AE. Clinical, laboratory, and neuroradiological data are discussed in terms of differential diagnosis between AE and GBM.
The presence of atypical brain MRI findings and the unresponsiveness to immunosuppressive treatment are major red flags in the differential diagnosis between AE and GBM. In these cases, a brain biopsy is necessary to confirm the diagnosis.
Atypical brain tumor presentation causes a diagnostic and therapeutic delay. A positive onconeural autoantibodies result should always be interpreted cautiously, considering the possibility of a false-positive test. A brain biopsy is mandatory for a definite diagnosis.
胶质母细胞瘤（GBM）是成人中最常见的原发性脑肿瘤。初始诊断通常基于临床和MRI表现，这可能会被误诊为其他神经系统疾病，包括自身免疫性脑炎（AE）。AE是一组异质性神经炎症性疾病，由于存在针对神经元突触或细胞表面抗原的自身抗体。在本报告中，我们描述了两例最初被误诊为AE的GBM特殊病例，重点关注诊断陷阱和治疗策略。
我们报告了两名患有高级别脑肿瘤的患者的病例，他们最初被误诊并接受了AE治疗。从AE和GBM的鉴别诊断角度讨论了临床、实验室和神经放射学数据。
非典型脑MRI表现的存在以及对免疫抑制治疗无反应是AE和GBM鉴别诊断中的主要警示信号。在这些病例中，需要进行脑活检以确诊。
非典型脑肿瘤表现会导致诊断和治疗延迟。考虑到假阳性检测的可能性，对肿瘤相关自身抗体检测结果呈阳性时应始终谨慎解读。明确诊断必须进行脑活检。
