成人脊髓內惡性星狀細胞瘤：病例報告

Adult Intramedullary Anaplastic Astrocytoma in the Spinal Cord: A Case Report

陳良城(Liang-Cheng Chen) ； 蔡高宗(Kao-Chung Tsai) ； 劉復康(Fu-Kong Lieu)

《中華民國復健醫學會雜誌》 27卷2期 (1999/06) Pp. 79-84

摘要

成人脊髓內惡性星狀細胞瘤為一少見的脊髓腫瘤。由於前驅症狀常被忽視，症狀期為時很短，加上臨床惡化進展非常迅速，往往疾病被診斷出來時，已是相當嚴重，同時也失去了治療的先機。本文報告一位48歲男性，原先被診斷為下腰椎椎間盤突出症合併神經根病變，經過了局部熱療等保守療法及手術治療後，症狀不僅沒有緩解反而更加急劇惡化。再經過詳細檢查及評估之後，第二次手術才進行腫瘤切除，組織病理報告證實為脊髓內惡性星狀細胞瘤。希望藉由此病例報告，建議在面對背痛的病人時，若發現病情惡化很快，並且有明顯感覺及運動功能障礙時，須將脊髓腫瘤列為重要的鑑別診斷。

關鍵字

脊髓腫瘤 ； 星狀細胞瘤 ； 退變

並列摘要

Adult anaplastic astrocytomas comprise a small subset of intramedullary spinal cord tumors and carry a dismal prognosis. Characteristically, a short prodrome occurs only several weeks before diagnosis, followed by progressive neurological deterioration and death. This article describes a 48-year-old male patient suffering from lower back pain with radiculagia and progressive weakness of both lower limbs for 5 months. The patient was initially diagnosed as having a lower lumbar
intervertebral disc herniation and underwent laminectomy with spinal rods instrumentation two months following the diagnosis. The symptoms gradually worsened and cauda equina syndrome developed thereafter. Two months later, a second subtotal cytoreductive surgery was performed and anaplastic intramedullary astrocytoma was proved by pathology results. Based on this case report, careful history taking and detailed examination should be emphasized in patients inflicted with lower back pain and progressive sensory and motor deficits.

並列關鍵字

spinal cord neoplasm ； astrocytoma ； anaplasia