脑胶质瘤临床误诊分析

Analysis of Clinical Misdiagnosis of Glioma

目的 探讨脑胶质瘤的临床特点及误诊原因,并总结防范误诊措施。方法 回顾分析2018年2月—2020年3月收治初期曾误诊的脑胶质瘤11例的病例资料。结果 本组11例以头痛、恶心、呕吐,受累侧肢体乏力、感觉和运动障碍,表情淡漠,癫痫发作,视物模糊为主要临床表现;肿瘤部位:右侧基底节区9例,左侧顶叶、左侧颞叶海马区各1例。4例据急性发病,有前驱上呼吸道感染史,头痛、呕吐、表情淡漠,颅压升高,头颅MRI显示颅内多发片状稍长T2、稍长T1信号,误诊为急性播散性脑脊髓炎;7例因头颅CT及MRI检查示右侧基底节区多个点片状低密度病灶或信号,误诊为急性脑梗死。误诊时间1~3个月。11例予相应治疗后症状不缓解,转我院神经外科行脑穿刺组织病理学检查,诊断为脑胶质瘤。11例确诊后均行手术治疗,4例经手术治疗联合术后辅助放化疗,症状缓解,随访1年无复发;7例开颅手术治疗,但病灶累及范围较大,切除较困难,故结束手术行放化疗。随访1年3例失访,2例死亡,2例病情稳定。结论 脑胶质瘤患者临床表现多样,若影像学表现为弥漫性、多发性病变时,极易误诊,遇到此类表现患者时,若按初诊疾病治疗后效果不佳,应考虑到脑胶质瘤可能,尽早行脑组织活检以确诊。

Objective To explore the clinical characteristics and causes of misdiagnosis of glioma,and to summarize the measures to prevent misdiagnosis.Methods The data of 11 cases of glioma misdiagnosed in our hospital from February 2018 to March 2020 were retrospectively analyzed.Results The main clinical manifestations of the 11 cases in this group were headache,nausea,vomiting,weakness of the affected side,sensory and motor disorders,apathy,seizures,and blurred vision.Tumor location involved the right basal ganglia in 9 cases,left parietal lobe in 1 case,and the left temporal lobe and hippocampus in 1 case.Four cases had acute onset,with a history of prodromal upper respiratory tract infection,headache,vomiting,apathy,and increased intracranial pressure.Cranial MRI showed multiple patches of slightly longer T2 and slightly longer T1 signals in the brain,and the patients were misdiagnosed as acute disseminated encephalomyelitis.Seven cases were misdiagnosed as acute cerebral infarction,because CT and MRI examinations of the head showed multiple patchy low-density foci or signals in the right basal ganglia.The duration of misdiagnosis was 1 to 3 months.The symptoms of 11 patients did not relieve after corresponding treatment,and they were transferred to Department of Neurosurgery of our hospital to undergo brain biopsy for histopathological examination.Eleven cases were diagnosed with glioma.All 11 cases were treated with surgery after diagnosis,and 4 cases were treated with surgery combined with postoperative adjuvant radiotherapy and chemotherapy.The symptoms were relieved,and there was no recurrence at 1-year follow-up.Seven cases were treated with craniotomy,but the lesions involved a large region,which,therefore,were difficult to resect.Thus,the surgery was terminated,and radiotherapy and chemotherapy were recommended.After 1 year of follow-up,3 cases were lost to follow-up,2 cases died,and 2 cases were stable.Conclusion The clinical manifestations of brain glioma patients are diverse.If the imaging manifestations are diffuse and multiple lesions,it is more likely to be misdiagnosed.When facing patients with such manifestations,the possibility of brain glioma should be considered if the effect of treatment according to the newly diagnosed disease is not favorable,and brain biopsy should be performed as soon as possible to confirm the diagnosis.