■成熟囊性畸胎瘤(MCT)是一种常见的卵巢肿瘤,在极少数情况下,进行恶性转化。已经发现,由于抗N-甲基-D-天冬氨酸受体(NMDAR)抗体的存在,MCT患者可能会出现精神症状,这是自身免疫性脑炎的根本原因。这里,我们介绍了第一例记录的抗NMDAR脑炎患者,该患者在MCT中也有低度胶质瘤形态.
■一名45岁女性出现癫痫发作,改变了意识,NMDAR抗体IgG滴度异常,和异常的脑MRI检查结果证实了抗NMDAR脑炎的诊断。体格检查显示,在子宫附件的超声检查中,左附件区域有一个椭圆形的混合回声肿块,大小为54×37mm。患者接受腹腔镜左卵巢和输卵管切除术。病理大体检查发现一堆灰红色囊性实性碎裂组织,大小7×6×2.2cm。组织学检查显示MCT的特征成分。此外,大体组织的固体成分显示出增殖和密集排列的星形胶质细胞,具有细胞异型性,GFAP和Olig-2阳性,IDH1和EMA阴性。Ki67指数大约是10%,提示存在低度胶质瘤病变。该患者被诊断为MCT恶性转化为低度胶质瘤的形态,未指定。卵巢肿瘤切除后,病人的精神症状得到改善。
■MCT内的低级别神经胶质瘤很少发生,抗NMDAR脑炎患者出现这种恶性转化的情况更为罕见.
UNASSIGNED: Mature cystic teratoma (MCT) is a common type of ovarian tumors that can, in rare cases, undergo malignant transformation. It has been discovered that MCT patients may experience psychiatric symptoms due to the presence of anti-N-methyl-D-aspartate receptor (NMDAR) antibodies, which is the underlying cause of autoimmune encephalitis. Here, we present the first documented case of a patient with anti-NMDAR encephalitis who also had a morphology of low-grade glioma within MCT.
UNASSIGNED: A 45-year-old woman presented with seizures, altered consciousness, abnormal NMDAR antibody IgG titers, and abnormal brain MRI findings confirm the diagnosis of anti-NMDAR encephalitis. Physical examination revealed an oval mixed echo mass measuring 54 × 37 mm in the left adnexal area on ultrasound of the uterine appendage. The patient underwent laparoscopic left ovarian and fallopian tube resection. The pathological gross examination revealed a pile of grayish-red cystic and solid fragmented tissue measuring 7 × 6 × 2.2 cm. Histological examination revealed characteristic components of MCT. Furthermore, the solid component of the gross tissue showed proliferative and densely arranged astrocytes with cellular atypia, which were positive for GFAP and Olig-2, negative for IDH1 and EMA. And the Ki67 index was approximately 10%, suggesting the presence of low-grade glioma lesions. The patient was diagnosed with malignant transformation of MCT into a morphology of low-grade glioma, not otherwise specified. After the removal of the ovarian tumor, the patient\'s psychiatric symptoms improved.
UNASSIGNED: Low-grade glioma within MCT is a rare occurrence, and the presence of this malignant transformation in patients with anti-NMDAR encephalitis is even more uncommon.