When gemistocytic astrocytes presence, should be upgraded to III, correct me please if I am wrong.

 弥漫浸润性星形细胞瘤（WHO 2级），若确有少突胶质细胞瘤成分，则为混合性少突星细胞瘤（WHO 2级）

 

学习了 

 谢谢马老师

 Thanks for Dr. Ma's description, I favor this is an astrocytoma.

This is no doubt a case of infiltrating glioma, either WHO grade II or grade III. Further classification and exact grading of the lesion require much more consideration. There are large gemistocytes as well as cells with perinuclear halos. The former are consistent with astrocytoma, while the latter suggest oligodendroglioma. Whether to classify this case as a pure astrocytoma or a mixed oligoastrocytoma is very subjective, and I usually would like to examine all available sections carefully before making such a decision. Can astrocytoma show perinuclear halos? Yes. What do I need to see before accepting the presence of an oligodendroglioma component in a glioma? The answer to this important question varies and depends on who you ask. I would like to see at least an area of incontrovertivle oligodendroglioma to do so - including uniform cells with round to oval nuclei and little cytoplasm, delicate capillary network, mucinous microcysts, calcospherites, minigemistocytes, nodular hypercellularity, etc. These would be much difficult to detect in a small biopsy even if they were there. That said, I have to examine the actual slides before deciding on this particular case whethe there is an oligodendroglioma component in the neoplasm. A thick-walled blood vessel is seen, but I am not convinced it is tumor neovasculature. I do not see tumor necrosis represented here, either. To accurately grade the glioma at hand, one needs to count mitoses of the case carefully, which is impossible to do on a few representative two dimensional photomicrographs. In my attempt to clarify a few important points I hope I did not confuse you.

 星形-少突胶质细胞瘤II级