胶质母细胞瘤（GBM）

Is this specimen you're showing from 6 months ago? If so, what was the pathologic diagnosis at the time of surgery? if not, has there been a local tumor recurrence and this specimen represents re-excised specimen? Please clarify for us because these information are important for interpretation. Thank you.

This is a hypercellular lesion with focal necrosis and surrounding reactive gliosis. Many component cells are plasma cells, or at least very plasmacytoid. I do not see typical foreign body giant cells or discrete epithelioid granulomas. At least some of these cells have enlarged, hyperlobated and hyperchromatic nuclei that are very atypical. There appears to be an additional population of proliferating spindled cells (Figures 8, 13, 15-17) that look very different from plasma cells. Without the help of more photos of HE-stained sections, immunohistochemical stains may definitely help (GFAP and CD138). If the original pathologic disgnosis was glioma, I suspect this may be a case of residual or recurrent high grade (WHO grade III or IV) fibrillary astrocytoma that was partially resected before and has been complicated by chronic infection and abscess formation.

谢谢马老师指点，

这个病人6个月以前曾经手术，诊断为胶质瘤III级，现在是复发，二次手术标本。请问按照07年who标准如何诊断？

 复发的胶质瘤在组织形态上往往会有很多变异，如本例出现的大量炎细胞浸润及脓肿形成等。

复发的胶质瘤往往向更高级别的肿瘤进展，本例可见栅栏样坏死，提示存在GBM成分，又有较多的梭形细胞成分，那会不会是胶质肉瘤。本例从组织学标准看是够4级了。

请标记GFAP、Nestin、S-100、SMA、Ki67，并染网纤