Intracranial plasmacytoma presenting as glioblastoma multiforme.
Intracranial plasmacytoma presenting as glioblastoma multiforme.
复制标题
颅内浆细胞瘤表现为多形性胶质母细胞瘤。
DOI：
10.1016/j.pjnns.2018.06.005
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发表时间：
2018
影响因子：
2.9
通讯作者：
R. Makarewicz
中科院分区：
文献类型：
--
作者：
Tomasz Wiśniewski;A. Żyromska;M. Birski;T. Szylberg;R. Makarewicz
浆细胞瘤是一组异质性肿瘤，包括多发性和孤立性浆细胞瘤以及其他免疫增殖性疾病。中枢神经系统（CNS）的孤立性髓外浆细胞瘤（SEP）是一种非常罕见的疾病，占所有恶性肿瘤的不到1%，约占血液恶性肿瘤的14%。一名37岁的男子来到急诊室，由于全身癫痫发作和几个星期的历史，麻木的左肩和左上肢。除了严重肥胖（体重140公斤）外，他其他方面都很健康。头部计算机断层扫描（CT）显示右半球有一个直径为2.5 cm的对比增强肿块，周围水肿。对患者进行抗水肿治疗，对照CT显示出被广泛水肿包围的尺寸为37 mm X 32 mm X 36 mm的对比度增强肿块（图1A），这强烈提示多形性胶质母细胞瘤（GBM）。由于放射学照片和对抗水肿治疗缺乏反应，患者被转诊至紧急手术（肿瘤根治性切除术），未进行任何其他初步诊断（MRI或活检）。令人惊讶的是，手术标本的组织病理学检查揭示了浆细胞瘤的特征，其显示出对CD 138（图1 B）、CD 79 A、CD 3、GFAP、Ki 67、波形蛋白和CD 10的免疫反应性，而对CD 20、BCL 6和CD 31无反应性。骨髓活组织检查、骨密度扫描以及血液（钙、b2-微球蛋白、白蛋白、M-蛋白）和尿液（M-蛋白）检查未显示任何病理学。切除后三个月，头部的对照磁共振成像（MRI）显示23 mm x 16 mm x 21 mm肿瘤，边缘造影增强不规则，对应于术后变化或残留/复发肿块（图1C）。结合计算机断层扫描（18 F-FDG PET/CT）的2-脱氧-2-[氟-18]-氟-D-葡萄糖正电子发射断层扫描未显示任何其他CNS病理学，除了肿块周围葡萄糖摄取增强（SUV 1.5），表明术后变化（图1D）。计划对患者进行放射治疗，以达到术后病理性肿块的体积（对比增强，neurologia i neurochirurgia polska 52（2018）543-545
Plasma cell tumors are a heterogeneous group of neoplasms that includes multiple and isolated plasmacytomas and other immunoproliferative diseases. An extremely uncommon form of the disease are solitary extramedullary plasmacytomas (SEPs) of the central nervous system (CNS) which account for less than 1% of all malignant tumors and about 14% of hematological malignancies. A 37-year-old man came to the casualty department due to generalized seizures and a several-week history of a numbness of the left shoulder and left upper limb. Apart from severe obesity (weight 140 kg), he was otherwise healthy. Computed tomography (CT) of the head revealed a contrast-enhanced mass of 2.5 cm in diameter with surrounding edema in the right hemisphere. The patient was administered an anti-edema treatment and a control CT revealed a contrast-enhancing mass with dimensions of 37mm x 32 mm x 36 mm surrounded by extensive edema (Fig. 1 A) which strongly suggested glioblastoma multiforme (GBM). Due to the radiological picture and the lack of response to the anti-edematous treatment the patient was referred to the urgent surgery (radical resection of the tumor) without any other preliminary diagnostics (MRI or biopsy). Surprisingly, the histopathological examination of the surgical specimen revealed the features of plasmacytoma showing immunoreactivity for CD138 (Fig. 1 B), CD79A, CD3, GFAP, Ki67, vimentin, and CD10 and no reactivity for CD20, BCL6 and CD31. The bone marrow biopsy, bone scintigraphy as well as blood (calcium, b2-microglobulin, albumin, M-protein) and urine (M-protein) tests did not show any pathology. Three months after the resection a control magnetic resonance imaging (MRI) of the head showed a 23 mm x 16 mm x 21 mm tumor with an irregular marginal contrast enhancement corresponding to either post-operative changes or a residual/recurrent mass (Fig. 1 C). The positron emission tomography with 2-deoxy-2-[fluorine-18]-fluoro-D-glucose integrated with the computed tomography (18F-FDG PET/CT) did not reveal any other CNS pathology except of an enhanced glucose uptake (SUV 1.5) around the mass which indicated post-operative changes (Fig. 1 D). The patient was scheduled for radiotherapy to the volume of the post-operative pathological mass (contrast enhanced on neurologia i neurochirurgia polska 52 (2018) 543–545