額葉星形細胞瘤

 

　　The patient was a 48-year-old male who presented with complaints of increasingly severe headaches. Workup at another hospital revealed a lucent left frontal lesion. The biopsy diagnosis was grade III astrocytoma. He was referred to our hospital after external radiation therapy was delivered. Neurological exam revealed mild bradykinesia, but was otherwise unremarkable.  He was admitted and underwent a left frontal lobectomy , with gross total tumor resection. One month later he underwent stereotactic implantation of brachytherapy catheters. He received 6000 rads to the margins of the tumor cavity. Subsequent scans revealed progressively worsening enhancement, edema? and shift around the tumor cavity. Reoperation was undertaken with resection of all grossly abnormal tissue. Pathologic **ysis revealed radiation necrosis and tumor. The patient is alive 5 years later, with no evidence of disease progression.

 

　　Case 6: Glioblastoma multiforme of frontal lobe

 

　　額葉多形膠母細胞瘤

 

　　A healthy 6-year-old woman presented with a 3-month history of dysphasia.   Computed tomography demonstrated a ring-enhancing lesion in the right frontal lobe. She was not immune-suppressed or on steroids. The rim was T2 hypointense and Tl hyperintense. There was a small amount of surrounding edema. Brain abscess was considered in the differential diagnosis? but a tumor was believed more likely, because; (1) there was an eccentric area of capsular thickening (2) edema was minimal, and (3) the clinical course was long. At operation, glioblastoma multiforme was encountered. Substances with unpaired electrons exhibit an unusual combination of increased Tl signal and decreased T2 signal termed paramagnetism. Methemoglobin, melanin, and gadolinium are familiar paramagnetic substances. In an abscess capsule, paramagnetic changes occur because macrophages release free-radicals that contain unpaired electrons. Although uncommon, clinicians should be aware that paramagnetic rim signal may also be observed in metastasis,  primary brain tumors, gran-ulomas like tuberculosis, and in large demyelinating plaques.

 

　　Case 7: Glioblastoma multiforme located near motor cortex

 

　　運動區(qū)附近的多形膠母細胞瘤

 

　　History

 

　　Patient A. L. is a 23-year-old right handed man from Hebei who works as a painter and has had nocturnal seizures for approximately two years.  In January the seizures increased in frequency and began to occur during the day. They are associated with turning of the head and shoulders to the right prior to generalization. The patient is confused and fatigued afterwards, but does not have a neurologic deficit. A scan was done in February and this demonstrates an area of nonenhancement in the posterior portion of the superior frontal convolution, with a small contrast enhancing area in the center of the  lesion. The latter approximately 3 mm, the former measures approximately 3. 5 cm. The scan was repeated recently and it appeared that the lesion had grown slightly. Stereotactic biopsy was recommended. The parent in fact was  scheduled for a biopsy in Hebei but they decided to seek another opinion.  The patient is presently on Dtlantin 100 mg three times per day. Past medical history is noncontributory, Family history and social history are not significant.

 

　　Physical Examination

 

　　The patient is a well nourished, well developed, thin, pleasant male who appears intellectually intact. Recent memory is intact? general ***rmation is good.Cranial nerve examination reveals no abnormalities, sensory examination is Intact to all modalities. Motor examination reveals no drift to distraction, and good strength in upper and lower extremities. There may be some weakness of the wrist extensors on the right, however. Deep tendon reflexes are symmetrical, the patient walks with a normal gait with a normal arm swing.

 

　　Radiographic Studies

 

　　MRI scan shows an approximately 3. 5 cm well-demarcated lesion in the posterior aspect of the left superior frontal convolution.

 

　　Impression

 

　　Probable low/intermediate grade glioma, possibly ganglio-glioma or ganglio-neurocytoma. If the lesion is anterior to the motor cortex, resection is recommended. If the lesion is within the motor cortex? a biopsy is recommended,

 

　　Hospital Course

 

　　The patient underwent magnetoencephalography (MEG)to map his primary motor cortex and define its relationship to the tumor.   This confirmed the clinical and radiographic impression that the tumor was anterior to the motor st**.

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