Two cases of intracranial gliomatosis in different types: clinical manifestations and radiological features

Abstract

Objective To report one case of gliomatosis cerebri (GC) and one case of leptomeningeal gliomatosis (LG), both of them were clearly diagnosed by brain biopsy. Methods and Results 1) The GC patient was a 48-year-old male who presented with epilepsy and focal neurological deficits. Cranial MRI revealed diffuse white matter lesions in bilateral cerebral hemispheres without obvious mass effect and enhancement. Immunohistochemical staining revealed that tumor cells and proliferative glial cells were positive for glial fibrillary acidic protein (GFAP). Ki-67 labeling index was about 10% . 2) The LG patient was a 30-year-old female who mainly presented with high intracranial pressure and epilepsy. Repeated cranial MRI revealed aggressive enlargement of subarachnoid space and ventricles, multiple encapsulated cysts in sulci and fissures, and parenchymal infiltration. Strong enhancement in meninges and the encapsulated cysts could be seen in contrast-enhanced images. Histologically, dense and uneven distribution of tumor cells was the main feature. Obvious atypia of nuclei and proliferation of small vessels could be seen. Tumor cells were positive for GFAP. Ki-67 labeling index was about 5% . By brain biopsy, both cases were diagnosed as anaplastic astrocytoma (WHO Ⅲ). The principle of treatment was temozolomide chemotherapy. Conclusions For intracranial gliomatosis, relatively distinct characteristics in brain MRI could indicate the diagnosis. Brain biopsy should be done early as possible for a clear diagnosis.

DOI: 10.3969/j.issn.1672-6731.2015.12.013