Progressive multifocal exophytic pontine glioblastoma: a case report with literature review

摘要

Multifocal pontine glioblastoma exhibiting an exophytic growth pattern in the cerebello-pontine angle(CPA) is rare.We present a case of a 5-year-old girl with consecutive neurological imaging and other clinical findings indicating progressive multifocal exophytic pontine glioblastoma.Three lesions were reported,of which two were initially presented,and one was developed 2 months later.One lesion demonstrated a progressing exophytic extension in the cistern of the left side of the CPA.The other two lesions were located and confined within the pons.Initial magnetic resonance imaging and positron emission tomography-computed tomography indicated low-grade glioma or inflammatory disease.However,2 and 3 months later,subsequent magnetic resonance spectroscopy(MRS) displayed elevated choline and depressed N-acetyl aspartate peaks compared with the peaks on the initial MRS,indicating a high-grade glioma.Subtotal resection was performed for the CPA lesion.Histopathologic examination showed discrepant features of different parts of the CPA lesion.The patient received no further chemotherapy or radiotherapy and died 2 months after surgery.The multifocal and exophytic features of this case and the heterogeneous manifestations on neurological images were rare and confusing for both diagnosis and surgical decision-making.Our case report may contribute knowledge and helpful guidance for other medical doctors.