“镜像”对称性星形细胞瘤1例分析并文献复习

“Mirror” Symmetric Astrocytoma: A Case Report and Literature Review

目的:报道1例"镜像"对称性星形细胞瘤病例,并通过文献回顾分析,探讨该病的临床表现、病理及影像学特征。方法:报道我院1例颅内"镜像"对称性星形细胞瘤患者的临床资料并结合文献进行回顾性分析。结果:患者为53岁男性,因"发作性意识丧失伴四肢抽搐半天"入院。头部MRI平扫+增强示:右侧额叶软化灶;另见左侧额叶斑片状长T1长T2信号,T2 Flair呈稍高信号,可见轻度强化。病理活检示:左侧额叶病变局部细胞密度增高,诊断星形细胞瘤(WHOⅡ级)。免疫组化:GFAP(+),Vim(+),S-100(+),NF(+),NSE(+),Ki-67 (+2%)。手术后患者恢复良好,继续行放疗和化疗。收集到近5年临床资料较完备的非同期多中心胶质瘤病例31例,最常见的首发症状为肢体抽搐,所有患者头颅磁共振平扫+增强均见病变部位团片状混杂异常信号伴强化,病理类型以星形细胞瘤多见。结论:非同期多中心胶质瘤可表现为肢体抽搐、头痛、偏身感觉障碍等;积极手术治疗,结合放疗、化疗及基因和生物学治疗的综合治疗原则对延长患者的生存期有利。

Objective: To report the clinical manifestations of a case of "Mirror" symmetric astrocytoma, and analyze its clinical, imaging and pathological features. Methods: One case of intracranial "Mirror" symmetric astrocytoma was reported, and the relevant literatures were reviewed and retrospectively analyzed.Results: The patient was a male, 53 years old, who was admitted to the hospital because of"a loss of paroxysmal consciousness with limbs twitching for half a day". The head MRI plain scanning and enhanced scanning displayed that the right frontal lobe existed a softening lesion;the left frontal lobe saw a patchy long T1 long T2 signal, and T2 Flair showed a slightly higher signal and mild enhancement. Surgical treatment was performed, and the left frontal lobe lesion was resected. Pathological biopsy: Left frontal lobe lesion had locally more intensive cells, and it was diagnosed as astrocytoma(WHO II). Immunohistochemistry: GFAP(+),Vim(+), S-100(+), NF(+), NSE(+), Ki-67(+2%). After operation, the patient recovered well and continuous radiotherapy and chemotherapy were recommended. We collected data of 31 cases of non-synchronous multicentric glioma reported in the last 5 years. Limb twitching is the most presented initial symptom. The plaque-like mixed abnormal signal and enhancement in different parts of the head was observed in all patients by plain and enhanced cranial MRI. The pathological type was more common in astrocytoma. Conclusion:Non-synchronous multi-centered gliomas can be characterized by limb convulsions, headaches, and partial sensory disturbances. For patients with intracranial astrocytoma, active surgical treatment combined with radiotherapy, chemotherapy and gene and biological treatment are beneficial to the survival of patients.