Glioblastoma Multiforme: Pitfalls in Early Diagnosis

多形性神經膠母細胞瘤－初期診断之陷阱

王爱民(Ay-Ming Wang) ； Catherine L. Joachim ； Jon-Kway Huang ； Calvin L. Rumbaugh

《中華放射線醫學雜誌》 10卷1期 (1985/03) Pp. 65-74

摘要

有三例臨床與CT初期表現異於平常一般徵候的多形性神經膠母細胞瘤，謹提出報告，供同道作為日後類似病例之警惕與參考。
第一例58歲男性，最初呈現左顳葉血腫，經手術清除，在三個月後CT檢查發現一邊綠顯像增加之低密度腫塊。第二例64歲女性，曾有左側TIA病史，腦CT檢查為正常，血管造影檢查發現左側內頸動脈近端狹窄，經動脈內膜切除術治療，兩個月後CT影像發現左側額頂葉呈現一密度增加的腫塊。第三例75歲婦人，初期臨床及CT表現為左葉血腫，經保守療法一週後，再作CT檢查發現原先血腫減小，但有一新的低密度腫塊（邊緣顯像增強）呈現於左額葉。三例病人皆經手術截取腦病灶，標本生檢病理報告證實為glioblastoma multiforme。
多形神經膠母細胞瘤偶有類似或併發TIA徵候者，有些則表現自發性腦內出血者，即使以腦CT檢查亦未必能顯示出腫瘤。文獻也有數例這樣的個案報告，所以遇見類似這種病例，如經過手術清理腦內血腫或動脈內膜切除術後，臨床症狀仍持續存在，甚或變壞者，追踪CT檢查（包括注射對比劑）是相當重要的。

並列摘要

Three cases of glioblastoma multiforme with unusual initial signs and symptoms are reported. One patient presented with a left temporal lobe hematoma which was evacuated. Three months later, a large rim-enhancing low density mass was seen on computerized tomogram (CT).
The second patient presented with a history of left-sided brain transient ischemic attacks (TIA) and a normal CT. Stenosis of the proximal left internal carotid artery was apparent on angiogram; this was treated by endarterectomy. Two months later an enhanced mass was found in the left frontoparietal area on CT.
The third patient presented with a left occipital lobe hematoma which was treated conservatively. One week later, a new low density lesion with rim enhancement was found in the left frontal lobe.
Glioblastoma multiforme was diagnosed in all three patients on brain biopsy.