Watanabe Chihiro, Sekine Tomokazu, Nakamura Kazuhiro, Muroi Ai, Ishikawa Eiichi, Komatsu Yoji
Department of Neurosurgery, Hitachi General Hospital, 2-1-1 Jonancho, Hitachi 317-0077, Japan.
Department of Neurosurgery, Institute of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan.
Radiol Case Rep. 2025 Aug 28;20(11):5730-5734. doi: 10.1016/j.radcr.2025.08.026. eCollection 2025 Nov.
Epithelioid glioblastoma (eGBM) is a rare subtype of glioblastoma, generally associated with a poorer prognosis than conventional GBM despite maximum resection and standard chemoradiotherapy. Here, we report a case of a 78-year-old man who presented with left hemiplegia and a well-circumscribed right frontal lobe lesion on imaging, initially suspected to be a metastatic brain tumor. Surgical resection revealed a firm, clearly demarcated mass. Histopathological examination showed features consistent with eGBM, including epithelioid and rhabdoid cells, necrosis, and high proliferative activity (Ki-67 index: 41%). Immunohistochemistry indicated IDH-wildtype GBM with negative V600E. Despite postoperative radiotherapy and temozolomide chemotherapy, the tumor recurred, and the patient died 1 year and 10 months after surgery. Even if a tumor appears well-circumscribed with minimal edema, a diagnosis of eGBM should be considered to avoid treatment delays if no primary lesion is detected. Following a diagnosis of eGBM, prognosis remains variable; therefore, careful pathological evaluation, including immunohistochemistry and molecular analysis, is essential to guide treatment decisions.
上皮样胶质母细胞瘤（eGBM）是胶质母细胞瘤的一种罕见亚型，尽管进行了最大限度的切除和标准的放化疗，但其预后通常比传统胶质母细胞瘤更差。在此，我们报告一例78岁男性患者，其影像学检查显示左侧偏瘫及右额叶有边界清晰的病变，最初怀疑为脑转移瘤。手术切除显示为质地坚硬、边界清晰的肿块。组织病理学检查显示具有与eGBM一致的特征，包括上皮样和横纹肌样细胞、坏死以及高增殖活性（Ki-67指数：41%）。免疫组织化学表明为异柠檬酸脱氢酶（IDH）野生型胶质母细胞瘤且V600E为阴性。尽管术后进行了放疗和替莫唑胺化疗，肿瘤仍复发，患者在手术后1年零10个月死亡。即使肿瘤看起来边界清晰且水肿轻微，如果未检测到原发灶，也应考虑诊断为eGBM以避免治疗延误。诊断为eGBM后，预后仍然多变；因此，包括免疫组织化学和分子分析在内的仔细病理评估对于指导治疗决策至关重要。
