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后颅凹肿瘤

shandongzhang 离线

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楼主 发表于 2006-10-07 11:21|举报|关注(0)
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女21岁,头痛头晕2个月加重2天,
MR:后颅凹肿瘤
手术见:肿瘤侵及颅内外,沿斜坡生长,包膜完整
后颅凹肿瘤图1
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后颅凹肿瘤图2
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后颅凹肿瘤图3
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后颅凹肿瘤图4
名称:图4
描述:图4
后颅凹肿瘤图5
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描述:图5
后颅凹肿瘤图6
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mjma 离线

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1 楼    发表于2006-10-07 13:37:00举报|引用
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A cerebellar tumor like this, occurring in a 21 year old, generates a list of differential diagnosis that includes medulloblastoma (anaplastic or large cell variant), atyical rhabdoid/teratoid tumor (AT/RT), and less likely, choroid plexus carcinoma and metastasis. Distinction between these possibilities depends on clinical history, MRI finding and immunohistochemistry. Histologic features of anaplastic medulloblastoma overlap with that of AT/RT. AT/RT often contains mesenchymal areas of spindle cells, whic are not seen here. The last photo appears to be synaptophysin immunostain, which is strongly positive in neoplastic cells. If so, anaplastic/large cell medulloblastoma would be favored. This said, I would like to see more photos before making a final diagnosis.
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聞道有先後,術業有專攻

shihuaiy 离线

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2 楼    发表于2006-10-09 17:17:00举报|引用
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完全同意楼上分析。另外,感觉细胞有些上皮样改变,高级别脑膜瘤是否也应在鉴别之列。

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the more we discuss, the more we learn from each other !!

mjma 离线

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3 楼    发表于2006-10-10 02:36:00举报|引用
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Malignant meningioma or rhabdoid meningioma may have similar histopathology, but the immunohistochemical staining pattern shown is not consistent with any antibody commonly used for meningioma. The neoplastic cells do form Homer-Wright rosettes, which are again consistent with medulloblastoma of the large cell/anaplastic type. I would love to be corrected of my interpretation.
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聞道有先後,術業有專攻

xiaohl 离线

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4 楼    发表于2006-10-20 15:35:00举报|引用
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请问免疫组化做的什么?
从发生部位及组织学形态看,觉得不大象大细胞性髓母.
更倾向于神经内分泌癌肿瘤(转移?原发:垂体瘤?)),需除外脑膜瘤(非典型性).
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5 楼    发表于2009-07-18 22:54:00举报|引用
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 请问zhangshandong老师最后诊断是什么
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6 楼    发表于2009-07-19 15:07:00举报|引用
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 ?
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7 楼    发表于2009-07-19 15:43:00举报|引用
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 学习
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满天星 离线

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8 楼    发表于2009-07-19 15:45:00举报|引用
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 21岁女性,:后颅凹包膜完整的肿瘤,:肿瘤沿斜坡生长,侵及颅内外,, 但肿瘤细胞有Homer-Wright 菊形团形成,免疫组化弥漫性阳性(可能为SYN),因此该例首先应考虑是间变性/大细胞性髓母细胞瘤。希望多做一些免疫组化进一步与恶性脑膜瘤或横纹肌样脑膜瘤及神经内分泌癌鉴别。
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xiaohl 离线

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9 楼    发表于2006-11-13 03:03:00举报|引用
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以下是引用mjma 在2006-10-7 13:37:00的发言:

A cerebellar tumor like this, occurring in a 21 year old, generates a list of differential diagnosis that includes medulloblastoma (anaplastic or large cell variant), atyical rhabdoid/teratoid tumor (AT/RT), and less likely, choroid plexus carcinoma and metastasis. Distinction between these possibilities depends on clinical history, MRI finding and immunohistochemistry. Histologic features of anaplastic medulloblastoma overlap with that of AT/RT. AT/RT often contains mesenchymal areas of spindle cells, whic are not seen here. The last photo appears to be synaptophysin immunostain, which is strongly positive in neoplastic cells. If so, anaplastic/large cell medulloblastoma would be favored. This said, I would like to see more photos before making a final diagnosis.

发生于21岁男性小脑类似这样的病变,需要跟多种肿瘤鉴别,包括髓母细胞瘤(间变或大细胞亚型),不典型畸胎瘤样/横纹肌样瘤,脉络丛癌以及转移性肿瘤等.需要结合临床病史、MRI表现以及免疫组化结果来进行鉴别.在组织学上,间变性髓母细胞瘤与AT/RT有所重叠,后者常常含有梭形细胞间叶成分,本例看不到这种现象.最后一张图看上去应该是SYN免疫染色,肿瘤细胞强阳性,如果确实如此的话,倾向于考虑间变性或大细胞性髓母细胞瘤.当然,在确诊前我希望看到更多的图片.

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xiaohl 离线

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10 楼    发表于2006-11-13 23:01:00举报|引用
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以下是引用mjma 在2006-10-10 2:36:00的发言:

Malignant meningioma or rhabdoid meningioma may have similar histopathology, but the immunohistochemical staining pattern shown is not consistent with any antibody commonly used for meningioma. The neoplastic cells do form Homer-Wright rosettes, which are again consistent with medulloblastoma of the large cell/anaplastic type. I would love to be corrected of my interpretation.

恶性脑膜瘤或横纹肌样脑膜瘤也可能出现相似的组织病理学改变,但该例显示的免疫组化染色模式不同于任何一种常用于脑膜瘤诊断的抗体.肿瘤细胞形成Homer-Wright 菊形团,这也与间变性/大细胞性髓母细胞瘤相吻合.

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