Sakamoto T, Sakakibara Y, Hayashi T, Yamashita K, Sekino H, Ozawa T, Tadokoro M
Department of Neurosurgery, St. Marianna University Toyoko Hospital.
No Shinkei Geka. 1995 Oct;23(10):941-5.
A case of recurrent pleomorphic xanthoastrocytoma (PXA) was reported. A 46-year-old male underwent total removal of mural nodule from cystic tumor in the left temporal lobe in 1986. Histological diagnosis was astrocytoma. There were no abnormal neurological signs or symptoms after the operation. However, 6 years after the operation he complained of strong unpleasant smell as of rotten onions and was admitted to our hospital. MRI revealed a cystic tumor with a mural nodule which was enhanced markedly by Gd-DTPA in the same location as previous tumor site. He was operated upon again and tumor was removed with the cyst wall. Histological diagnosis was PXA. Surgical procedures for removal of cystic PXA has been controversial; removal of tumor only, tumor removal with biopsy of cyst wall, or tumor removal with resection of cyst wall. Real reason for recurrence of this tumor in our case is unknown. However, since astrocytoma cells were found in the biopsy specimen of the cyst wall at time of the first operation, the tumor might have recurred from these cells. Therefore, this time we removed not only the mural nodule but also the cyst wall, because the cyst wall peeled off easily. We would like to propose that PXA cyst walls should be resected, whenever possible, in order to accomplish total removal of tumor.
报告了一例复发性多形性黄色星形细胞瘤（PXA）。一名46岁男性于1986年接受了左颞叶囊性肿瘤壁结节的全切术。组织学诊断为星形细胞瘤。术后无异常神经体征或症状。然而，术后6年他主诉有强烈的如烂洋葱般的难闻气味，遂入住我院。MRI显示在与先前肿瘤部位相同的位置有一个带壁结节的囊性肿瘤，该壁结节在注射钆喷酸葡胺（Gd-DTPA）后有明显强化。他再次接受手术，肿瘤连同囊壁一并切除。组织学诊断为PXA。囊性PXA的手术方式一直存在争议；是仅切除肿瘤、切除肿瘤并对囊壁进行活检，还是切除肿瘤并切除囊壁。本病例中该肿瘤复发的真正原因尚不清楚。然而，由于在首次手术时囊壁的活检标本中发现了星形细胞瘤细胞，肿瘤可能是从这些细胞复发的。因此，这次我们不仅切除了壁结节，还切除了囊壁，因为囊壁很容易剥离。我们建议，只要有可能，PXA的囊壁都应切除，以实现肿瘤的全切。
