clinicaloncologyКлинический случай в онкологииClinical Case in Oncology3034-14773034-4018ОНКОПРАКТИК10.62546/3034-1477-2025-3-3-49-65clinicaloncology-136Research ArticleКЛИНИЧЕСКИЕ СЛУЧАИCASE REPORTSСложности дифференциальной диагностики опухолевых и опухолеподобных поражений головного мозга у пациента с ВИЧ-инфекцией: обзор литературы и клинический случайIntracranial solitary fibrous tumor: Difficulties in differential diagnosis of tumors and tumor-like lesions in a patient with HIV-infection: case report and literature reviewhttps://orcid.org/0000-0002-1180-4886СпасенниковВ. В.SpasennikovVladislav V.

625039, г. Тюмень, ул. Мельникайте, д. 75

75, Melnikaite St., Tyumen, 625039

ТалыбовР. С.TalybovRustam S.

Талыбов Рустам Сабирович 

625039, г. Тюмень, ул. Мельникайте, д. 75

625003, г. Тюмень, ул. Володарского, д. 6 

75, Melnikaite St., Tyumen, 625039

6, Voldarsky St., Tyumen, 625003

rustam230789@gmail.comhttps://orcid.org/0009-0008-6417-1999КлещевниковаТ. М.KleschevnikovaTatiana M.

625039, г. Тюмень, ул. Мельникайте, д. 75

75, Melnikaite St., Tyumen, 625039

https://orcid.org/0000-0002-0899-0809ПавловаВ. И.PavlovaValeria I.

625039, г. Тюмень, ул. Мельникайте, д. 75

625041, г. Тюмень, Барнаульская ул., д. 32 

75, Melnikaite St., Tyumen, 625039

32, Barnaulskaya St., Tyumen, 625041

https://orcid.org/0000-0003-4871-2341ТрофимоваТ. Н.TrofimovaTatiana N.

197022, Санкт-Петербург, ул. Льва Толстого, д. 6–8 

6–8 L. Tolstoy Str., St. Petersburg 197022

ГБУЗ ТО «Областная клиническая больница № 2»РоссияRegional Clinical Hospital No. 2Russian FederationГБУЗ ТО «Областная клиническая больница № 2»; ФГБОУ ВО «Тюменский государственный медицинский университет» Минздрава РоссииРоссияRegional Clinical Hospital No. 2; Tyumen State Medical UniversityRussian FederationГБУЗ ТО «Областная клиническая больница № 2»; Многопрофильный клинический медицинский центр «Медицинский город»РоссияRegional Clinical Hospital No. 2; Multidisciplinary Clinical Medical Center «Medical City»Russian FederationФГБОУ ВО «Первый Санкт-Петербургский государственный медицинский университет им. акад. И.П.Павлова» Минздрава РоссииРоссияPavlov First Saint Petersburg State Medical UniversityRussian Federation202528012026334965Copyright © Спасенников В.В., Талыбов Р.С., Клещевникова Т.М., Павлова В.И., Трофимова Т.Н., 20262026Спасенников В.В., Талыбов Р.С., Клещевникова Т.М., Павлова В.И., Трофимова Т.Н.Spasennikov V.V., Talybov R.S., Kleschevnikova T.M., Pavlova V.I., Trofimova T.N.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.oncocase.ru/jour/article/view/136

Согласно статистике Всемирной организации здравоохранения на сегодняшний день насчитывается почти 40 млн человек, инфицированных ВИЧ. Специфика эпидемиологического течения ВИЧ-инфекции представлена широким рядом тяжелых форм заболеваний с преимущественным вовлечением в патологический процесс центральной нервной системы. В связи с вариабельностью поражения головного мозга возникают трудности в диагностике, особенно когда речь идет об поражениях, не связанных с ВИЧ-инфекцией. Представлен случай мужчины 40 лет с остро возникшим левосторонним гемипарезом и дезориентацией. Пациент с установленным диагнозом ВИЧ-инфекции, без получения антиретровирусной терапии. Уровень CD4+-лимфоцитов составил 180 кл/мкл. Титры антител к T. gondii составили 1:400. Магнитно-резонансная томография (МРТ) головного мозга выявила внутримозговое образование в области базальных ганглиев справа с кольцевидным типом контрастирования, ограничением диффузии от солидного компонента, наличием сосудистых шунтов и микрокровоизлияний и высокими значениями перфузионных показателей. Пациенту была проведена стереотаксическая биопсия, послеоперационные результаты гистологических исследований подтвердили диагноз первичной нейроэпителиальной опухоли — глиобластома, без специфических признаков (БДУ, ВОЗ, 2021). Корректная и своевременная идентификация характера поражения головного мозга необходима для выбора верной стратегии лечения и, как следствие, снижения смертности. Использование мультипараметрического МРТ-протокола рекомендовано на этапе дифференциальной диагностики поражений головного мозга у больных ВИЧ-инфекцией.

Based on current World Health Organization statistics, today there were an estimated 40 million people living with HIV. The specific epidemiological course of HIV infection is represented by a wide range of severe forms of diseases with a predominance of involvement of the central nervous system in the pathological process. Due to the variability of cerebral lesions, there are difficulties in identifying and diagnosing the pathological process, especially when it comes to a tumor process unrelated to HIV infection. A 40-year old man presented with left hemiparesis and headaches. He was diagnosed with human immunodeficiency virus (HIV) in 2020 and does not treat using antiretroviral (ARV) drugs. The CD4+ lymphocyte level was 180 cells/μl. The titers of antibodies to T.gondii were 1:400. Brain magnetic resonance imaging (MRI) revealed an intraaxial mass in the basal ganglia region on the right side, with ring-shaped contrast enhancement, restricted diffusion and extensive perifocal edema, small foci of hemorrhages and vascular shunts, and high perfusion levels. The patient underwent a stereotactic biopsy of the brain mass and postoperative pathological report confirmed the diagnosis of a primary neuroepithelial tumor: Glioblastoma, Not Otherwise Specified (NOS, WHO 2021). Correct and timely detection of the nature of brain lesion is necessary to select the correct treatment strategies and, as a result, reduce mortality. The use of multiparametric MRI protocol recommended to the differential diagnosis of brain lesions in patients with HIV infection.

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The authors declare that there are no conflicts of interest present.