Acta Neuropathologica:一例COVID-19的青年人H3K27M突变型弥漫性脑胶质瘤伴随广泛的瘤内微血栓

2020-07-18 MedSci原创 MedSci原创

2019年新型冠状病毒病(COVID-19)的出现给肿瘤患者带来了独特的挑战。除了对获得治疗的影响外,初步研究表明癌症患者感染和死亡的风险增加。

COVID-19与高凝状态和脑血管意外发生率有关,新型冠状病毒病对肿瘤生物学的影响,人们知之甚少。恶性肿瘤与高凝状态密切相关,因年龄和肿瘤类型而异。脑瘤与成人血栓栓塞症的高风险相关,但与儿童无关。作者讨论一例年轻COVID-19成人丘脑高级胶质瘤中肿瘤微环境中广泛血管血栓形成的组织病理学证据。

一名21岁女性,表现为头痛、视力模糊和呕吐。她的神经系统检查没有发现异常,病人被诊断为紧张型头痛。其头部CT显示一个巨大的(4.3厘米)上丘脑肿块引起梗阻性脑积水。她随后因疝失代偿,并接受了紧急心室引流术。术后头颅CT和MRI显示引流管放置成功,但肿瘤和脑室明显出血,透明隔移位。患者通过鼻咽拭子检测SARS-CoV-2呈阳性,并表现出典型的COVID-19相关凝血病的发现,包括D-dimer 升高,凝血酶原或活化部分凝血活酶时间无变化。病人没有出现呼吸系统症状,胸片也没有肺部疾病的迹象。

方法:组织活检显示高级别胶质瘤,肿瘤细胞显示H3K27M染色,H3K27me3降低,Ki-67高,值得注意的是,肿瘤显示多处出血、血管血栓形成和纤维蛋白沉积的微血栓,经PTAH染色证实。肿瘤表现为实质和血管周围巨噬细胞浸润,SARS-CoV-2原位杂交阴性。

结果意义:在COVID-19感染中,大脑有一种独特的易形成血栓的倾向,考虑到肿瘤内微血栓与胶质瘤整体预后之间的不良联系,文章病例提出了一个关键问题,即COVID-19相关的凝血病对肿瘤生物学、免疫微环境和患者临床病程的影响。作者的病例提出了一个假设,即COVID-19相关的凝血病可能以一种尚未被认识的方式影响癌症的长期肿瘤行为和疾病进展。

原文链接

Pun, M., Haggerty-Skeans, J., Pratt, D. et al. H3K27M-mutant diffuse midline glioma with extensive intratumoral microthrombi in a young adult with COVID-19-associated coagulopathy. Acta Neuropathol 140, 227–229 (2020). https://doi.org/10.1007/s00401-020-02184-0

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    2021-02-09 yb6560
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    2021-03-31 zll0625
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    2020-10-26 windight
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