Craniotomy for a Large and Aggressive De Novo Cavernous Malformation Resection in the Basal Ganglia Region
Craniotomy for a Large and Aggressive De Novo Cavernous Malformation Resection in the Basal Ganglia Region
复制标题
开颅手术对基底神经节区域进行大面积、激进的海绵状血管瘤新生切除术
DOI：
10.1016/j.wneu.2018.06.067
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发表时间：
2018
影响因子：
2
通讯作者：
Wang Chao
中科院分区：
文献类型：
--
作者：
Yan Zhiyong;Che Shusheng;Jiao Yingbin;Wang JianPeng;Li Xingze;Wang Chao
背景脑海绵状血管畸形（CCM）存在于高达0.5%的一般人群。尽管CCM被认为是先天性病变，但许多报告已在家族性CCM患者和颅脑放疗后患者中观察到新生形成。在这些情况下，有很少的证据，以潜在的病因CCM.Case DescriptionWe介绍了一个48岁的妇女与病史的子宫内膜增生伴随子宫内膜息肉表现出一个大的从头CCM，增长到一个大的尺寸在一段时间内的20个月。先前的磁共振成像扫描显示无异常。该CCM表现出以反复明显出血和癫痫发作为特征的侵袭性生物学行为。组织学检查证实CCM的诊断。在这里，我们讨论了这些lesions.ConclusionsGiven患者的病史和影像学检查结果的增长机制，我们提出，从头CCM可以直接从血管生成性增殖，继发于BCL-2过表达的根本原因。我们推测，雌激素的不适当分泌可能引发了伴随内皮细胞增殖的遗传级联反应，因此，雌性激素可能在影响CCM的生物学行为中起重要作用。雌激素与CCM的关系有待进一步研究。
BackgroundCerebral cavernous malformations (CCMs) are present in up to 0.5% of the general population. Although CCMs have been considered congenital lesions, numerous reports have observed de novo formations in patients with the familial form of CCM and in patients after cranial radiotherapy. Outside of these circumstances, there is scant evidence as to the potential etiologies of CCM.Case DescriptionWe present a 48-year-old woman with a medical history of endometrial hyperplasia concomitant endometrial polyps demonstrating a large de novo CCM, which grew to a large size in a period of 20 months. A previous magnetic resonance imaging scan showed no abnormalities. This CCM exhibited aggressive biological behavior characterized by recurrent overt bleeding and seizure. Histopathologic analysis confirmed the diagnosis of CCM. Here, we discuss the growth mechanisms of these lesions.ConclusionsGiven the patient's medical history and imaging findings, we propose that de novo CCMs can arise directly from angiogenic proliferation, secondary to BCL-2 overexpression from underlying causes. We hypothesize that inappropriate secretion of estrogen could have set off a genetic cascade with attendant endothelial proliferation.Thus, female hormones may play an important role in influencing the biological behavior of CCMs. The relationship between estrogen and CCM needs further investigation.