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Characteristic analysis of diffuse leptomeningeal glioneuronal tumor misdiagnosed as cryptococcal meningitis in adolescent female |
| Yi Bao*, Lei Gao, Jing Xiao, Huihui Wu, Ying Wang, Xinyu Du, Quanying Liu |
| Department of Neurology, Taihe Hospital Affiliated to Hubei University of Medicine, Shiyan, Hubei 442000, China |
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Abstract Diffuse leptomeningeal glioneuronal tumor (DLGNT) in adolescent female is rare and easy to be misdiagnosed due to its nonspecificity. This article described the characteristics of an adolescent female DLGNT patient with no history of tumor whose first symptoms are headache and vision loss, and analyzed the causes why DLGNT is easy to be misdiagnosed as cryptococcal meningitis. Treatment remedies: the adolescent female presented with progressive exacerbations of headache, vomiting and vision loss after general treatment. Dynamic monitoring of routine biochemical changes in cerebrospinal fluid (CSF) found abnormal high CSF pressure and protein, repeated examination of antibodies and acid-fast bacilli were negative, and high-throughput pathogen gene examination excluded viral meningitis, tuberculous meningitis and other diseases. To save the optic nerve, the Ommaya capsule was implanted to reduce the intracranial pressure. After diagnostic antifungal treatment, the patient’s condition did not improve. To identify the etiology, extensive meningeal enhancement was eventually detected by enhanced magnetic resonance imaging (MRI), and highly atypical tumor cells were identified by repeated examination of fresh CSF cytology. Post treatment evaluating: for DLGNT, consult oncology. Meningeal biopsy and PET-CT (positron emission tomographycomputed tomography) examination were recommended, and intrathecal chemotherapy and whole-brain radiotherapy were performed according to the examination results. But the patient’s family refused to have a meningeal biopsy and asked to be released from the hospital. Conclusions: the adolescent female without a history of tumor can not rule out the disease, and cryptococcal meningitis also has meningeal enhancement. The gold standard for the diagnosis of DLGNT is to find cancer cells. There is no effective cure for DLGNT, the timely placement of Ommaya sac can significantly improve the quality of the patient’s life, and the active adoption of targeted therapy is expected to extend the patient’s survival.
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| Keywords
diffuse leptomeningeal glioneuronal tumor (DLGNT)
cryptococcal meningitis
cytology
Ommaya sac
targeted therapy
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Issue Date: 23 March 2020
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