胶质瘤术后继发胶质肉瘤1例并文献复习

Secondary gliosarcoma after glioma operation: a case report and literature review

目的 探讨脑胶质瘤术后继发颈髓胶质母细胞瘤再继发小脑胶质肉瘤(GS)的诊治过程及治疗方法。方法 回顾性分析贵阳市第二人民医院神经外科2020年1月收治的1例脑胶质瘤术后继发颈髓胶质母细胞瘤再继发小脑GS患者的临床资料,结合相关文献进行复习。结果 该患者右侧颞叶病灶显微手术切除满意,术后诊断弥漫型星形细胞瘤(WHOⅡ级),随访未见原位复发;术后3年复查见左侧海马区肿瘤、颈椎C2~3颈髓肿瘤,行颈髓肿瘤手术切除后病理诊断胶质母细胞瘤(WHOⅣ级),术后放化疗治疗2个月后复查见颈髓内多发异常信号,放化疗后7个月见左侧海马区肿瘤消失,放化疗后11个月见右侧小脑半球肿瘤,手术切除小脑肿瘤后病理诊断GS(WHOⅣ级),目前该患病情稳定,继续放化疗随访中。结论 GS进展快、恶性度高、预后差,临床医师要提高对GS的认识,首次手术做到扩大切除或完全切除,术后辅以放化疗,争取延缓肿瘤复发时间,提高患者生活质量。

Objective To explore the diagnosis and treatment of secondary cervical spinal glioblastoma and secondary cerebellar gliosarcoma(GS)after glioma surgery.Methods The clinical data of a patient with cervical glioblastoma secondary to cerebellar GS after brain glioma surgery admitted to the Department of Neurosurgery,the Second People's Hospital of Guiyang in January 2020 were analyzed retrospectively,and the related literature was reviewed.Results The patient was satisfied with the microsurgical resection of the right temporal lobe lesion.Diffuse astrocytoma was diagnosed postoperatively(WHO gradeⅡ).No recurrence was found in situ during follow-up;Three years after the operation,there were tumors in the left hippocampus and in the C 2-3 spinal canal of the cervical spine,pathological diagnosis of glioblastoma after surgical resection of cervical spine tumors(WHO gradeⅣ),after 2 months of postoperative radiotherapy and chemotherapy,there were multiple abnormal signals in the cervical spine,and 7 months after radiotherapy and chemotherapy,the left side was seen The tumor in the hippocampus disappeared,11 months after radiotherapy and chemotherapy,a tumor in the right cerebellar hemisphere was seen.After surgical removal of the cerebellar tumor,a pathological diagnosis of GS(WHO gradeⅣ)was performed.The patient is currently in stable condition and is continuing follow-ed up with radiotherapy and chemotherapy.Conclusions GS progresses rapidly,has a high grade of malignancy,and poor prognosis.Clinicians should improve their understanding of GS,achieve extended resection or complete resection for the first operation,supplemented by postoperative radiotherapy and chemotherapy,and strive to delay tumor recurrence time and improve patient's quality of life.