长期生存继发性胶质肉瘤一例并文献复习

Long term survival secondary gliosarcoma:a case report and literature review

目的探讨继发性胶质肉瘤的可能发病原因及诊断治疗。方法回顾性分析1例反复行胶质瘤切除并最终发展为继发性胶质肉瘤患者的临床资料,并对相关文献进行复习。结果患者,女,42岁,头部MRI显示左侧颞叶占位性病变;首次手术切除,术后病理诊断为间变性少突胶质细胞瘤(WHOⅢ级);术后第59个月发现右侧额叶占位病变,第二次手术切除,术后病理诊断为胶质母细胞瘤(WHO分级Ⅳ级),术后1个月行调强适形放射治疗+替莫唑胺化疗6个疗程;第二次术后31个月,患者右侧额叶肿瘤再次复发,第三次手术切除,术后病理诊断为胶质肉瘤(WHO分级Ⅳ级),第三次术后1个月调强适形放射(IMRT)治疗+威罗菲尼靶向治疗,随访12个月尚无临床症状。结论手术联合放化疗治疗及靶向治疗可能延迟胶质肉瘤患者的无进展生存期。

Objective To investigate the possible causes,diagnosis and treatment of secondary gliosarcoma.Methods The clinical data of a patient who underwent repeated glioma resection and eventually developed into secondary gliosarcoma were analyzed retrospectively,and the relevant literature was reviewed.Results A 42 year old female patient presented with left temporal lobe space occupying on head MRI.The patient underwent the first surgical resection and was pathologically diagnosed as anaplasti coligodendroglioma(WHO gradeⅢ).59 months after operation,the right frontal lobe tumor was found and resected for the second time.The pathological diagnosis was glioblastoma(WHO gradeⅣ).Intensity modulated radiation therapy(IMRT)and temozolomide chemotherapy were performed 1 month after operation for 6 courses.31 months after the second operation,the tumor in the right frontal lobe recurred again and the third surgical resection was performed.The postoperative pathological diagnosis was gliosarcoma(WHO gradeⅣ).One month after the third operation,intensity modulated radiation therapy(IMRT)and targeted therapy with Vemurafenib was performed.The patient survived until now.Conclusion Surgery combined with chemo therapy,radiotherapy and targeted therapy may delay progression free survival in patients with gliosarcoma.