title: Progressive multifocal exophytic pontine glioblastoma: a case report with literature review.
abstract: 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.
authors.affiliation: Neurosurgery Department, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, 510180, Guangdong, P. R. China.
authors.forename: Fanfan
authors.initials: F
authors.lastname: Chen
authors.affiliation: Neurosurgery Department, Shenzhen Second People's Hospital, Shenzhen University, Shenzhen, 518000, Guangdong, P. R. China.
authors.forename: Zongyang
authors.initials: Z
authors.lastname: Li
authors.affiliation: Oncology Department, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, 510180, Guangdong, P. R. China.
authors.forename: Chengyin
authors.initials: C
authors.lastname: Weng
authors.affiliation: Neurosurgery Department, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, 510180, Guangdong, P. R. China.
authors.forename: Peng
authors.initials: P
authors.lastname: Li
authors.affiliation: Neurosurgery Department, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, 510180, Guangdong, P. R. China.
authors.forename: Lanbo
authors.initials: L
authors.lastname: Tu
authors.affiliation: Neurosurgery Department, Shenzhen Second People's Hospital, Shenzhen University, Shenzhen, 518000, Guangdong, P. R. China.
authors.forename: Lei
authors.initials: L
authors.lastname: Chen
authors.affiliation: Neurosurgery Department, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, 510180, Guangdong, P. R. China.
authors.forename: Wei
authors.initials: W
authors.lastname: Xie
authors.affiliation: Record Department, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, 510180, Guangdong, P. R. China. ling7810@126.com.
authors.forename: Ling
authors.initials: L
authors.lastname: Li
mesh_terms: D001224:Aspartic Acid / Q000031:analogs & derivatives* / Q000378:metabolism; D020295:Brain Stem Neoplasms / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000601:surgery; D002675:Child, Preschool; D002794:Choline / Q000378:metabolism*; D003937:Diagnosis, Differential; D017809:Fatal Outcome; D005260:Female; D005909:Glioblastoma / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000601:surgery; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D064847:Multimodal Imaging; D000072078:Positron Emission Tomography Computed Tomography / Q000379:methods
chemical_list: D001224:Aspartic Acid; C000179:N-acetylaspartate; D002794:Choline
keywords: Brainstem; Cerebello-pontine angle; Glioma; Multiple lesion; Pontine