Intradural, extramedullary anaplastic astrocytoma arising from the first sacral nerve root.

摘要: A 48-year-old woman presentedwith a 6-month history of lumbosacral pain with sciatic distribution and paresthesia in the left S1 dermatome. She showed no motor weakness or bladder rectal dysfunction. The preoperativemagnetic resonance image (MRI) lumbar spine an intradural, extramedullary cysticmass extendingalong nerve root through intervertebral foramen (Figure 1). Thepatient underwentmicroscope-assistedneurosurgical tumor resection via posterior approach. Intraoperatively, was regarded as peripheral sheath tumor. Histologic examination revealed moderately cellular astrocytic glioma thatdiffusely infiltrated thenerve (Figure2A). tumorcellshadatypical,moderatelypleomorphicnuclei formed fibrillary glial matrix. Immunohistochemical analyses demonstrated positivity for acidic protein R132Hmutant isocitratedehydrogenase 1 (IDH1) cells (Figure2B).Many tumorcellsdisplayednuclear accumulationof suppressor p53. analysis neurofilament proteins confirmed infiltrative, intraneural growth by demonstrating residual fibers within tissue 2C). Based on histologic immunohistochemical features, thetumorwasclassifiedasanaplasticastrocytoma (WorldHealthOrganizationgrade III).Pilocyticastrocytomawasconsidered differential diagnosis. However, infiltrative pattern, well strong R132H-mutant IDH1 p53 positivity, argued favor diffuse glioma. Additional cranial spinal MRI did not provide evidence anaxial originof this unusually locatedanaplastic astrocytoma. patientwastreatedwith local radiotherapy(6-weekcumulativedose, 60 Gy) chemotherapy (temozolomide, 140 mg/d), given concomitantly to aswell after radiotherapy (six 28-day cycles: 5days per oral application temozolomide, 23 days paused). At last follow-up visit 6months operation, progression detected new neurological deficits were reported (Karnofsky Performance Status Scale, 80).