Wakuta Naoki, Tsugu Hitoshi, Nishiyama Kenichi, Aoki Mikiko, Abe Hiroshi
Department of Neurosurgery, Fukuoka University Chikushi Hospital, Fukuoka, JPN.
Department of Neurosurgery, Fukuoka Red cross Hospital, Fukuoka, JPN.
Cureus. 2025 Feb 24;17(2):e79589. doi: 10.7759/cureus.79589. eCollection 2025 Feb.
Adult pilocytic astrocytoma often presents with more aggressive behavior and poorer clinical outcomes than generally appreciated as pilocytic astrocytoma. Additionally, mortality increases with age at diagnosis; even more so for intraventricular lesions. Adult intraventricular pilocytic astrocytoma is extremely rare, and the clinical characteristics and pathological information are not well-described. We report a 75-year-old woman who presented with a progressive gait disorder, cognitive function decline, and impaired consciousness. Magnetic resonance imaging revealed hydrocephalus and an intraventricular tumor extending along the medial wall of the lateral ventricle, with another isolated lesion. Endoscopic surgical resection was performed to remove the tumor at the septum pellucidum safely, and the histologic and molecular findings were consistent with pilocytic astrocytoma. This case involved unique characteristics as the oldest known patient with intraventricular pilocytic astrocytoma at the rare location of the septum pellucidum and with multiple lesions. This case may aid the diagnosis in similar cases. It is important to consider this diagnosis in the differentials for intraventricular neoplasms. Further studies to elucidate specific molecular findings and indications for appropriate treatment are required to improve patient outcomes.
与一般认为的毛细胞型星形细胞瘤相比，成人毛细胞型星形细胞瘤通常表现出更具侵袭性的行为和更差的临床预后。此外，死亡率随诊断时的年龄增加而上升；脑室病变患者的死亡率上升更为明显。成人脑室毛细胞型星形细胞瘤极为罕见，其临床特征和病理信息尚无充分描述。我们报告一例75岁女性患者，表现为进行性步态障碍、认知功能下降和意识障碍。磁共振成像显示脑积水以及一个沿侧脑室内壁延伸的脑室肿瘤，还有一个孤立性病变。通过内镜手术安全切除了透明隔处的肿瘤，组织学和分子学检查结果与毛细胞型星形细胞瘤一致。该病例具有独特特征，是已知年龄最大的脑室毛细胞型星形细胞瘤患者，肿瘤位于罕见的透明隔部位且为多发病变。该病例可能有助于类似病例的诊断。在鉴别诊断脑室肿瘤时考虑这一诊断很重要。需要进一步研究以阐明具体的分子学发现和合适治疗的指征，从而改善患者预后。
