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- 右侧颞部肿瘤
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zhongshihua 离线
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zhongshihua 离线
- 帖子：1608
- 粉蓝豆：0
- 经验：1651
- 注册时间：2006-09-11
- 加关注 | 发消息
此肿瘤部分细胞具有横纹肌样特点，正如mjma教授所讲，此种细胞可见于多种脑肿瘤。但该肿瘤似乎还有以下特征：(1)与脑膜可能有联系（图1所示，一侧为纤维结缔组织）；（2）肿瘤内富于纤维间质，其中可见扩张的血管（图9图10）；（3）细胞上皮样特点明显，相互之间粘附性强，有合体样排列特点（图18图19）；（4）核内包含体较多。以上特点多见于脑膜瘤。结合横纹肌样细胞特点，考虑高级别脑膜瘤（如Rhabdoid meningioma ）可能性大。建议做免疫组化与胶质肿瘤或色素细胞性肿瘤鉴别。
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Though no meningothelial whorls, syncytia or psammoma bodies are seen, the intranuclear pseudoinclusions and high-power views in the uploaded photos are consistent with WHO grade III rhabdoid meningioma. Rhabdoid meningioma is a recently recognized but rare variant of meningioma that reportedly has aggressive biologic behavior. Rhabdoid cells in rhabdoid meningiomas are usually seen only focally, a feature similar to chordoid meningioma that makes microscopic examination of all resected tissue the only sure way to rule these two variants out. The minimum quantitative diagnostic criterion (% of tumor areas with rhabdoid cells, or how large an individual area of rhabdoid cells has to be present) for rhabdoid meningioma has not been clearly defined. This is complicated by the fact that some cases of rhabdoid meningioma display rhabdoid cells only in the recurrent tumors. Most rhabdoid meningiomas, however, have areas with characteristic meningothelial features and features of atypical meningiomas (necrosis, prominent nucleoli, high mitotic activity, patternless growth and brain invasion).
More recently, the prognostic significance of finding rhabdoid cells focally in otherwise benign (WHO grade I) meningiomas has been questioned. In my own experience, neoplastic cells with rhabdoid features can be found very focally in benign meningiomas. I also question whether this very focaly finding is sufficient to upgrade the tumor from WHO grade I to grade III.
Many tumors in or outside of CNS may show cells with rhabdoid features. In the CNS, rhabdoid cells can be seen in atypical rhabdoid/teratoid tumor (AT/RT), primary (and metastatic) leptomeningeal melanoma, choroid plexus carcinoma, large cell/anaplastic medulloblastoma, supratentorial PNET, anaplastic plasmacytoma and glioblastoma. Other than metastatic melanoma, cells in a metastatic poorly differentiated carcinoma or sarcoma may appear rhabdoid. Therefore pertinent clinical history and immunohistochemistry workup are essential before a final diagnosis of rhabdoid meningioma is made.
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