小児脊髄混合腫瘍 gliofibroma/pilocytic astrocytoma の 1 例

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We report an extremely rare case of composite gliofibroma and pilocytic astrocytoma. An 11-year-old girl had a 2-month history of back pain. A marked swelling of the cervical region of the spinal cord was seen on magnetic resonance (MR) imaging. Ring-like enhancement within the spinal cord at C4-C7 and heterogenous enhancement at the dorsal aspect of the C1-C7 section of the cord were seen following administration of gadolinium diethylenetriamine pentaacetic acid. Positron emission tomography scans revealed a high uptake of ^<18>F-fluorodeoxyglucose and ^<11>C-methionine. The patient underwent an expansive laminoplasty and a biopsy of the dorsal cervical tumor. The histopathological finding was consistent with gliofibroma. Postoperatively the patient had remained stable for 3 months, after which back pain returned. MR images showed that the tumor had developed to involve the cord from the medullo-cervical junction to T4. Radiation therapy was then started, and three months later, the second surgery was performed. On performing an incision of the dorsal lesion, we encountered cystic cavities surrounding by a grayish soft tumor. Following a biopsy, draining tubes were inserted into the cavities at the level of C5 and the cervico-medullary junction. The histopathological diagnosis was pilocytic astrocytoma. Gliofibroma is a benign tumor composed of cells exhibiting both glial and mesenchymal differentiation. The neoplastic glial differentiation is highlighted by positive immunohistological staining with glial fibrillary acidic protein, S-100 protein, and MIB-1, while the mesenchymal one is characterized by a dense proliferation of fibroblastic spindle cells. Combined pilocytic astrocytoma and gliofibroma of the spinal cord in the present case seems to be first report in the literature and should be added to differential diagnosis of intramedullary spinal cord tumors.
日本脊髄外科学会の論文
2002-07-31

小児脊髄混合腫瘍 gliofibroma/pilocytic astrocytoma の 1 例

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