Glioblastoma of central nervous system with signet⁃ring⁃like cell and ganglion cell differentiation: a case report and review of literatures

Abstract

Objective To study the clinical manifestations and pathological features of glioblastoma of central nervous system (CNS). Methods The clinical manifestations, histopathology and immunophenotype features were studied in one case of glioblastoma of CNS with signet⁃ring⁃like cell and ganglion cell differentiation, immunohistochemistrical assay was used for diagnosis and differentiation, and related literatures were reviewed. Results A 29⁃year⁃old man mainly presented with dizziness, headache, and progressive aggravated descent memory and vision. MRI demonstrated a mass associated with hemorrhage, involving gray ⁃ white matter of the right frontal lobe near the median line. The tumor measuring 4.50 cm × 5.00 cm × 5.00 cm had abundant blood supply and part of it invaded the left frontal lobe along the corpus callosum. The mass was solid, soft and grey ⁃ red in color. The histopathological examination revealed the tumor mainly composed of gliomatous cells arranging in solid sheets. Multi⁃ or mono⁃nucleated giant cells, vascular proliferation and palisading necrosis were observed. The tumor cells were characterized by atypia, hyperchromasia and high mitotic activity, and some cells presented as signet⁃ ring⁃like cell and ganglion cell differentiation. The immunohistochemistry showed that glial fibrillary acidic protein (GFAP), neurofilament protein (NF), nestin (Nes) and protein gene product 9.5 (PGP9.5) were positive in cytoplasm, and some cells expressed chromogranin A (CgA) and synaptophysin (Syn), and P53 protein (P53) in nuclei of tumor cells was positive. Ki⁃67 nuclear antigen index (MIB⁃1) was 20%-30%. Conclusion Glioblastoma is the most malignant astrocytoma and common primary tumor of CNS, but rarely with signet⁃ring⁃like cell and ganglion cell differentiation. It usually occurs in adults between 45 and 70 years old. The prognosis is poor.

DOI：10.3969/j.issn.1672-6731.2010.05.015