| Li Wang,Rongqing Li,Xudong Feng,Shuling Song,Yong Zhang. Extramedullary skeletal muscle metastasis of glioblastoma: A case report and literature review. Oncol Transl Med, 2016, 2: 189-193. |
| 胶质母细胞瘤髓外骨骼肌转移临床病理观察及分析 |
| Extramedullary skeletal muscle metastasis of glioblastoma: A case report and literature review |
| Received:April 27, 2016 Revised:July 21, 2016 |
| DOI：10.1007/s10330-016-0157-5 |
| 中文关键词: 胶质母细胞瘤；转移；组织病理学 |
| 英文关键词: glioblastoma; metastasis; histopathology |
| 基金项目:国家自然科学基金项目（面上项目，重点项目，重大项目） |
| Author Name | Affiliation | E-mail | | Li Wang | Department of Pathology, Kunming General Hospital, Kunming 650032, China | 2001wl@163.com | | Rongqing Li | Department of Radiation Oncology, First Affiliated Hospital of Kunming Medical University, Kunming 650032, China | lrqmxl@126.com | | Xudong Feng | Department of Radiation Oncology, First Affiliated Hospital of Kunming Medical University, Kunming 650032, China | fxd23@sina.com | | Shuling Song | Department of Pathology, Kunming General Hospital, Kunming 650032, China | 871819779@qq.com | | Yong Zhang* | Department of Radiation Oncology, First Affiliated Hospital of Kunming Medical University, Kunming 650032, China | newkaryon@163.com |
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| 中文摘要: |
| 目的 探讨胶质母细胞瘤髓外转移的临床病理学特征、免疫表型及诊断要点。方法 对1例发生髓外骨骼肌转移的胶质母细胞瘤病例进行临床特征、HE和免疫组化染色分析。结果 患者男性，24岁，行左颞顶叶多形性胶质母细胞瘤（WHOⅣ级）切除术，术后行TOMO放射治疗并同步替莫唑胺化疗。术后一年9个月，发现髓外腰肌转移，并行转移灶切除术。镜检：转移灶较原发灶病理形态发生改变，转移灶中可见大量异型肿瘤细胞呈巢团状浸润骨骼肌组织，肿瘤由两种不同形态的细胞交织组成：一种为较均一、一致的小圆细胞，胞浆较丰富，核深染，嗜碱性，核仁小或无核仁；另一种细胞体积大，合体状，胞浆丰富，胞核大小不一，核形不规则，嗜碱性，部分空泡状，部分深染。免疫组化：两种不同形态的肿瘤细胞免疫组化表现亦不相同：呈小圆形的肿瘤细胞成分GFAP阴性，S-100弱阳性，具有更高的p53表达率（约60%肿瘤细胞阳性），ki-67增殖指数高（40%），部分表达神经干细胞标记Nestin和神经母细胞标记NSE和CD56。而巨细胞样瘤细胞呈GFAP和S-100强阳性，p53表达率和ki-67增殖指数低（均约10%），Nestin、NSE和CD56表达强度下降。结论 胶质母细胞瘤罕见发生髓外转移，肿瘤胶质干细胞可能参与转移的发生。由于患者在发生转移时可无中枢神经系统症状，在随访期间发生的任何不适均应予以重视。 |
| 英文摘要: |
| Objective: The aim of the study was to explore the clinicopathologic, immunophenotypic, and diagnostic
features of extramedullary metastases of glioblastoma.
Methods: One case of extramedullary skeletal muscle metastasis of glioblastoma was studied, including
the clinical, histological, and immunohistochemical features.
Results: A 24-year-old man underwent surgical resection for glioblastoma (WHO grade IV) in the
left temporal parietal region followed by radiotherapy and temozolomide therapy. One year and nine
months later, he developed an extramedullary skeletal muscle metastasis in L4, and the histology
was remarkably different from that of the primary glioblastoma specimen. The immunohistochemical
analysis also showed changes. In the metastasis, the small cells were negative for GFAP; weakly
positive for S-100; and positive for nestin, NSE, and CD56, with 60% of cells positive for p53 and 40%
positive for Ki-67. The giant cells showed strong positivity for GFAP and S-100, and weak expression
of p53, Ki-67, nestin, NSE, and CD56. The primary glioblastoma specimen showed strong positivity
for GFAP and S-100 and was negative for NSE, nestin, and CD56, with around 25% of the tumor cells
positive for p53 and a Ki-67 labeling index of 20%.
Conclusion: Extraneural metastasis (ENM) is a rare complication of glial tumors and glioma stem
cells may be related to the metastasis. Since extraneural metastasis may occur in patients without
central nervous symptoms, any unusual signs during the follow-up of patients diagnosed with glioblastoma
should not be underestimated. |
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