Perifocal Inflammatory Reaction with Volume Fluctuation Caused by Diagnostic Radiation-Induced Regression in Germinoma Makes Histological Diagnosis Difficult despite Its Disappearance following Treatment: A Significant Pitfall and Countermeasures to It.
Perifocal Inflammatory Reaction with Volume Fluctuation Caused by Diagnostic Radiation-Induced Regression in Germinoma Makes Histological Diagnosis Difficult despite Its Disappearance following Treatment: A Significant Pitfall and Countermeasures to It.
复制标题
生殖细胞瘤诊断性放射诱导消退引起的局灶周围炎症反应和体积波动，尽管治疗后消失，但仍使组织学诊断变得困难：一个重大陷阱及其对策。
DOI：
10.1159/000450583
复制
发表时间：
2017
影响因子：
0.7
通讯作者：
Fujii Y.
中科院分区：
文献类型：
--
作者：
Yoneoka Y;Yoshimura J;Okada M;Fujii Y.
我们提出一个儿童神经垂体性生殖细胞瘤的病例，其周围有炎症反应(PIR)，体积波动是由诊断放射诱导消退(DRIR)引起的。靶点活检未能证实组织学，因为PIR几乎没有任何生殖细胞瘤细胞。肿瘤体积的DRIR相关波动将生殖细胞瘤伪装成炎症。我们分析了脑脊液(CSF)并检测到高水平的胎盘碱性磷酸酶(PLAP)，证实神经垂体病变为生殖细胞瘤，并将患者从放化疗成功带到完全缓解。生殖细胞瘤旁的PIR(PIRAG)在放化疗后完全消失，但几乎不含生殖细胞瘤细胞。检测脑脊液PLAP水平可补充生殖细胞瘤的诊断，降低误诊风险。当怀疑生殖细胞瘤时，神经外科医生应记住PIRAG、DRIR和脑脊液PLAP的诊断价值。
We present a pediatric case of neurohypophyseal germinoma with a perifocal inflammatory reaction (PIR) with volume fluctuation caused by diagnostic radiation-induced regression (DRIR). On-target biopsy failed to confirm the histology because PIR hardly contained any germinoma cells. DRIR-related fluctuation of the tumor volume disguised germinoma as inflammation. We analyzed the cerebrospinal fluid (CSF) and detected a high level of placental alkaline phosphatase (PLAP), which demonstrated the neurohypophyseal lesion to be germinoma and brought the patient from successful radiochemotherapy up to complete remission. PIR adjacent to the germinoma (PIRAG) disappeared completely following radiochemotherapy, although it contained almost no germinoma cells. Examination of the CSF-PLAP level can complement the diagnosis of germinoma and will decrease the risk of misdiagnosis. Neurosurgeons should keep in mind PIRAG, DRIR, and the diagnostic value of CSF-PLAP when germinoma is suspected.