Primary Glioblastoma Multiforme in the Pineal Region: A Case Report with Diagnostic Imaging Findings, Treatment Response, and Literature Review

原發於松果體區域的多型性神經膠母細胞瘤：一個結合影像診斷、治療成果以及文獻回顧的病例報告

阮昱翔(Yu-Hsiang Juan) ； 許銘益(Ming-Yi Hsu) ； 饒啓明(Kee-Min Yeow) ； 莊啓政(Chi-Cheng Chuang) ； 容世明(Shih-Ming Jung) ； 蘇奕豪(I-Hao Su)

《中華放射線醫學雜誌》 35卷2期 (2010/06) Pp. 115-123

摘要

雖然多型性神經膠母細胞瘤佔了在中樞神經系統裡面超過一半的原發性腫瘤，但是位於松果體區域的多型性神經膠母細胞瘤卻是非常的稀少。到目前為止，僅有18篇發表過的病例。我們報告一例原發於松果體區域的多型性神經膠母細胞瘤的罕見個案。一位32歲男性以頭痛、視覺扭曲以及暈眩作為初始症狀。安排了電腦斷層、核磁共振影像及腦部血管攝影等檢查後發現了一個位於松果體區域的腫瘤，並發現了腫瘤有跨越胼胝體侵犯的典型“蝴蝶樣”特色，且具有高度水分子表觀擴散係數(ADC value)而懷疑了多型性神經膠母細胞瘤的可能性。經部份切除後的腫瘤病理切片檢查進一步證實為多型性神經膠母細胞瘤。自初次診斷後，病患於是接受了手術以及合併了放射線治療與化學治療，並存活了至少超過一年。於是本篇主要提出了此病例個案的影像學特徵與治療方式，並回顧了過去文獻及進一步的相關探討。

並列摘要

Glioblastoma multiforme (GBM) is one of the most common primary tumors of the central nervous system, comprising up to half of all primary brain tumors, however, primary GBM of the pineal region is extremely rare. To our knowledge, there are only 18 reported cases. We report a rare case of pineal GBM in a 32-year-old male who presented with headache, visual image distortion, and vertigo. Computed tomography, magnetic resonance imaging, and cerebral angiography revealed a tumor mass in the pineal region. The mass was diagnosed as a glioblastoma following subtotal removal. After combined surgery and concurrent chemoradiotherapy treatment, our patient survived longer than l year after the initial diagnosis. Here, we present the radiographic features and treatment strategy of pineal GBM, with a review of the literature.