Koczyk Kacper, Nowak Arkadiusz, Machnicki Marcin M, Michałowski Łukasz Zdzisław, Maj Edyta, Stoklosa Tomasz, Kunert Przemysław
Department of Neurosurgery, Central Clinical Hospital, Medical University of Warsaw, Warsaw, Poland.
Doctoral School, Medical University of Warsaw, Warsaw, Poland.
Case Rep Oncol. 2025 Apr 17;18(1):682-693. doi: 10.1159/000545250. eCollection 2025 Jan-Dec.
Intramedullary glioblastoma is a rare entity comprising 1.4-9% of spinal gliomas. Spinal cord radiation-induced gliomas are unique, with only 13 cases reported to date.
A 53-year-old female with a history of mediastinal Hodgkin lymphoma treated with chemotherapy and radiotherapy who subsequently developed thyroid cancer and breast cancer throughout her life was admitted due to slowly progressing spastic tetraparesis. Cervical MRI revealed an intramedullary lesion at the C4-T1 level, enlarging the spinal cord, with a heterogenous contrast enhancement and a lesion within T1 vertebral body showing contrast enhancement. Whole-body F-FDG-PET/CT revealed increased radionuclide uptake within the cervical spinal cord at the C2-C7 level and a focus of increased metabolic activity within the T1 vertebral body. The patient underwent a C4-T2 laminectomy with tumor debulking, and a biopsy of the T1 vertebral body was taken. Closure was performed with thecal sac expansion using a fascia lata graft and open-door laminoplasty. The histomolecular results confirmed the diagnosis of glioblastoma, IDH-wildtype (CNS WHO G4), in the cervical spinal cord lesion and breast cancer metastasis in the T1 vertebral body. Postoperatively, the patient experienced progression of lower extremities and left arm paresis. No adjuvant therapy was administered due to neurological deficit progression. The patient died 6 months after surgery.
We report a case of an intramedullary glioblastoma in a patient with a history of radiation and multiple neoplasms located at the irradiation field borders. The full molecular analysis allowed for classification of the tumor as glioblastoma, IDH-wildtype (CNS WHO G4), and screening for germinal mutations potentially predisposing to spontaneous neoplasm development.
髓内胶质母细胞瘤是一种罕见的实体瘤，占脊髓胶质瘤的1.4%-9%。脊髓辐射诱发的胶质瘤很独特，迄今为止仅报道过13例。
一名53岁女性，有纵隔霍奇金淋巴瘤病史，接受过化疗和放疗，随后一生中又患了甲状腺癌和乳腺癌，因缓慢进展的痉挛性四肢轻瘫入院。颈椎MRI显示C4-T1水平有一髓内病变，脊髓增粗，有不均匀强化，T1椎体有一病变呈强化表现。全身F-FDG-PET/CT显示C2-C7水平颈椎脊髓内放射性核素摄取增加，T1椎体有一代谢活性增加灶。患者接受了C4-T2椎板切除术及肿瘤减瘤术，并对T1椎体进行了活检。使用阔筋膜移植行硬脊膜囊扩张及开门式椎板成形术进行缝合。组织分子学结果证实颈椎脊髓病变为胶质母细胞瘤，异柠檬酸脱氢酶（IDH）野生型（世界卫生组织中枢神经系统肿瘤分类G4级），T1椎体为乳腺癌转移。术后，患者下肢及左臂轻瘫病情进展。因神经功能缺损进展未给予辅助治疗。患者术后6个月死亡。
我们报告了一例有放疗史且在放疗野边界有多发性肿瘤的患者发生髓内胶质母细胞瘤的病例。全面的分子分析使肿瘤被分类为胶质母细胞瘤，IDH野生型（世界卫生组织中枢神经系统肿瘤分类G4级），并筛查了可能易患自发性肿瘤的胚系突变。
