Publication: A case of primary diffuse leptomeningeal gliomatosis predominantly ınvolving the cervical spinal cord and mimicking chronic meningitis
Abstract
Gliomaların her hangi parenkimal bir yerleşim göstermeksizin primer olarak leptomeningeal tutulum ile ortaya çıkmaları son derece nadirdir. Histolojik olarak oligoastrositom tanısı konulan bir primer diffüz leptomeningeal gliomatozis olgusu sunulmaktadır. Elli yaşındaki bayan hasta bulantı, kusma ve baş ağrısı şikayetleri ile başvurmuştur. Kranial ve servikal manyetik rezonans (MR) görüntüleme incelemeleri kranioservikal bileşkeden başlayarak C4 seviyesine kadar her hangi bir parenkim tutulumu olmaksızın dura kalınlaşması ile uyumlu görünüm ortaya koymuştur. Beyin omurilik sıvısı (BOS) incelemelerinde her hangi bir atipik hücre saptanmamış olmakla birlikte protein seviyesinde artış, glukoz seviyesinde ise azalma saptanmıştır. Hastaya C1 seviyesinden tanısal amaçlı biyopsi yapılmıştır. Biyopsi materyaline fenotipik olarak astrositom ve oligodendrogliom özellikleri de içeren primer diffüz leptomeningeal gliomatozis tanısı konulmuştur.
Gliomas may rarely arise in the leptomeninges without any evidence of intraaxial involvement. A case of primary diffuse leptomeningeal gliomatosis (PDLG) histologically diagnosed as oligoastrocytoma is presented. A 50-year-old woman presented with nausea, vomiting and headache. Magnetic resonance imaging (MRI) of cranium and cervical region revealed dural thickening starting from the craniocervical junction to the level of C4 without any parenchymal lesions. CSF examination showed an increase in protein and decrease in glucose levels. There were neither any kind of atypical cells nor any kind of growth in bacterial cultures. The patient underwent biopsy at the level of C1 for diagnosis. The specimen was diagnosed as primary diffuse leptomeningeal gliomatosis, with phenotypic features of astrocytoma and oligodendroglioma.
Gliomas may rarely arise in the leptomeninges without any evidence of intraaxial involvement. A case of primary diffuse leptomeningeal gliomatosis (PDLG) histologically diagnosed as oligoastrocytoma is presented. A 50-year-old woman presented with nausea, vomiting and headache. Magnetic resonance imaging (MRI) of cranium and cervical region revealed dural thickening starting from the craniocervical junction to the level of C4 without any parenchymal lesions. CSF examination showed an increase in protein and decrease in glucose levels. There were neither any kind of atypical cells nor any kind of growth in bacterial cultures. The patient underwent biopsy at the level of C1 for diagnosis. The specimen was diagnosed as primary diffuse leptomeningeal gliomatosis, with phenotypic features of astrocytoma and oligodendroglioma.