Primary glioblastoma of the cerebellopontine angle in adults

Case report

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Gliomas are rare entities in the cerebellopontine angle (CPA) in adults. The authors present clinical, neuroradiological, serological, and neuropathological findings in a 60-year-old man with an extraaxial CPA glioblastoma arising from the proximal portion of cranial nerve VIII. The patient presented with progressive left-sided deafness and left-sided facial palsy lasting less than 2 months and progressive dysarthria and dysphagia lasting 2 weeks. Preoperative neuroimaging suggested the diagnosis of CPA meningioma with “dural-tail” sign and involvement of the internal auditory canal. Serological examination showed an increase in the malignant markers of ferritin and neuron-specific enolase, which suggested underlying malignancy. The tumor was subtotally removed, and it was confirmed to be completely separated from the brainstem and cerebellum. Cranial nerves VII and VIII were destroyed and sacrificed. Transient severe bradycardia occurred during surgery due to entrapment of the caudal cranial nerve complex by the tumor in such an infiltrative way. The neuropathological examination revealed a glioblastoma. The patient underwent no further treatment and died of cachexia 2 months postoperatively. To the authors' knowledge, this represents the first case of a primary glioblastoma in the CPA in an adult. A high index of suspicion along with reliance on clinical assessment, radiological findings, and serum detection of specific malignant markers is essential to diagnose such uncommon CPA lesions.

Abbreviations used in this paper: CN = cranial nerve; CNS = central nervous system; CPA = cerebellopontine angle; DTPA = diethylenetriamine pentaacetic acid; IAC = internal auditory canal; NSE = neuron-specific enolase.

Article Information

Address correspondence to: Bo Wu, M.D., Ph.D., Department of Neurosurgery, Sichuan Provincial People's Hospital, No. 32, West Section 2, First Ring Road, Chengdu 610072, Sichuan Province, China. email: wuboscph@sina.com.

Please include this information when citing this paper: published online January 21, 2011; DOI: 10.3171/2010.12.JNS10912.

© AANS, except where prohibited by US copyright law.

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Figures

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    Left: Plain axial CT scan revealing a CPA tumor (tu) with heterogeneous density. Right: Bone window image demonstrating modest enlargement of the left IAC.

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    Magnetic resonance images. A: Noncontrast axial T1-weighted image revealing a predominantly hypointense left CPA tumor. B: Axial T2-weighted image showing a predominant hyperintense lesion with extensive peritumoral edema. C: Axial image obtained after administration of Gd-DTPA, revealing a heterogeneously enhancing CPA tumor in a ringlike way with a dural-tail sign along the posterior surface of the petrous bone as well as a triangular enhancing enlargement in the left IAC (arrow). D: Coronal image obtained after enhancement, demonstrating tumor extension into the IAC (arrow).

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    A: Photomicrograph displaying a highly cellular tumor consisting of atypical glial tumor cells with frequent mitotic activity and high nuclear/cytoplasmic ratios. B: Marked coagulation necrosis (nec) in the tumor; however, no typical pseudopalisading necrosis is visible. C: Marked microvascular proliferation (arrows) in the tumor. D: Staining for GFAP reveals diffuse immunoreactivity in the tumor cells. E: Immunohistochemical staining for p53 reveals diffuse immunoreactivity in the tumor cells. H & E (A–C); original magnification × 400 (A, C, and E), × 100 (B), and × 200 (D).

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