Negro Alberto, D'Agostino Vincenzo, Covelli Eugenio Maria, Gemini Laura, Gragnano Eduardo, Tortora Mario, Elefante Andrea, Chiapparini Luisa, Russo Camilla
Neuroradiology Unit, Ospedale del Mare, via Enrico Russo, 80147 Naples, Italy.
Neuroradiology Unit, "Sant'Anna e San Sebastiano" Hospital, 81100 Caserta, Italy.
J Clin Med. 2025 May 29;14(11):3807. doi: 10.3390/jcm14113807.
: Glioblastoma (GBM) is the most common primary brain tumor in adults, with a poor prognosis and survival. Although typically presenting with focal neurological deficits, seizures, or cognitive decline, GBM can occasionally mimic autoimmune encephalitis (AE), leading to significant diagnostic delay. The overlap in clinical, radiological, and serological findings between GBM and AE underscores the need for thorough evaluation. : We retrospectively reviewed cases of patients diagnosed between 2016 and 2023 with pathology-confirmed GBM, critically rethinking those cases initially diagnosed with AE at symptom onset. The diagnostic workup included magnetic resonance imaging (MRI), cerebrospinal fluid (CSF) analysis, autoantibody testing, and whole-body nuclear scanning to exclude extracranial malignancies. : We found five female patients diagnosed with GBM who initially presented with signs and symptoms suggestive for AE. Initial MRI showed non-specific brain tissue alterations, without definitive tumor features. CSF analysis was largely unremarkable, though some cases exhibited positive autoantibodies. Despite therapy, clinical deterioration and follow-up MRI revealed infiltrative intra-axial lesions with contrast enhancement, leading to pathology-confirmed GBM diagnoses. All patients had poor prognoses, with a mean survival of 10 ± 4 months. : GBM can mimic AE, delaying appropriate treatment. In patients with atypical MRI findings and suboptimal response to therapy, early follow-up imaging and biopsy should be considered to exclude malignancy. A multidisciplinary approach is critical for timely diagnosis and improved management.
胶质母细胞瘤(GBM)是成人中最常见的原发性脑肿瘤,预后和生存率较差。尽管GBM通常表现为局灶性神经功能缺损、癫痫发作或认知功能下降,但它偶尔也会模仿自身免疫性脑炎(AE),导致显著的诊断延迟。GBM和AE在临床、影像学和血清学检查结果上的重叠突出了进行全面评估的必要性。
我们回顾性地分析了2016年至2023年间诊断为病理确诊GBM的患者病例,并对那些在症状发作时最初被诊断为AE的病例进行了严格的重新评估。诊断检查包括磁共振成像(MRI)、脑脊液(CSF)分析、自身抗体检测和全身核扫描以排除颅外恶性肿瘤。
我们发现有五名女性患者被诊断为GBM,她们最初表现出提示AE的体征和症状。最初的MRI显示脑组织有非特异性改变,没有明确的肿瘤特征。脑脊液分析大多无明显异常,不过有些病例显示自身抗体呈阳性。尽管进行了治疗,但临床病情恶化,后续MRI显示轴内浸润性病变伴有强化,最终经病理确诊为GBM。所有患者预后都很差,平均生存期为10±4个月。
GBM可模仿AE,延误适当治疗。对于MRI表现不典型且治疗反应欠佳的患者,应考虑早期进行随访成像和活检以排除恶性肿瘤。多学科方法对于及时诊断和改善治疗管理至关重要。