IDH野生型胶质母细胞瘤伴自发性经硬脑膜及颅骨侵犯：一例病例报告及文献复习

文献信息

中文摘要

胶质母细胞瘤（GBM），IDH野生型，是侵袭性最强的成人型弥漫性胶质瘤。尽管在开颅手术、放疗或其他干预后可能发生颅外扩散，但治疗前自发性经硬脑膜及颅骨侵犯极为罕见。我们报告一名37岁女性，表现为长期右侧颞顶叶头痛并急性加重伴呕吐。计算机断层扫描和磁共振成像显示右侧颞部肿块，伴瘤内出血、瘤周水肿，并连续延伸穿过硬脑膜和颞骨进入颞肌。病变经经颅入路切除，术后影像显示大体全切除。组织学检查显示浸润性高级别胶质肿瘤，伴活跃的核分裂活性和栅栏状坏死。免疫组化和分子学发现，包括IDH1/IDH2突变缺失，支持IDH野生型胶质母细胞瘤、CNS WHO 4级的诊断。术后18个月，患者仍存活。本病例突出了GBM中一种罕见的原发性颅外延伸模式，并提示在无既往干预的情况下，直接连续性经硬脑膜侵犯是一种可能的播散途径。

英文摘要

Glioblastoma (GBM), IDH-wildtype, is the most aggressive adult-type diffuse glioma. Although extracranial spread may occur after craniotomy, radiotherapy, or other interventions, spontaneous transdural and calvarial invasion before treatment is exceedingly rare. We report a 37-year-old woman who presented with long-standing right temporal-parietal headache and acute worsening with vomiting. Computed tomography and magnetic resonance imaging demonstrated a right temporal mass with intratumoral hemorrhage, peritumoral edema, and contiguous extension through the dura and temporal bone into the temporalis muscle. The lesion was resected through a transcranial approach, and postoperative imaging showed gross total resection. Histological examination demonstrated an infiltrating high-grade glial neoplasm with brisk mitotic activity and palisading necrosis. Immunohistochemical and molecular findings, including the absence of IDH1/IDH2 mutations, supported a diagnosis of glioblastoma, IDH-wildtype, CNS WHO grade 4. At 18 months after surgery, the patient remained alive. This case highlights a rare pattern of primary extracranial extension in GBM and suggests direct contiguous transdural invasion as a plausible route of spread in the absence of prior intervention.