毛细胞黏液性星形细胞瘤伴局灶性栅栏状排列

 毛细胞黏液性星形细胞瘤伴局灶性栅栏状排列 真的很少见

 黏液型毛细胞性星形细胞瘤

 黏液型毛细胞性星形细胞瘤（ pilomyxoid  astrocytoma）

新版WHO 即第四版已将该瘤定为II级。今天刚拿到新书，并谢谢香港中文大学病理系李晓明博士。

 a great case.

 老的诊断名称:极性胶质母细胞瘤,伴局灶性毛细胞性星形细胞瘤分化;

现在应诊断为: 毛细胞黏液性星形细胞瘤伴局灶性栅栏状排列,

毛粘星较之毛细胞性星形细胞瘤, 往往边界不清,浸润性较强,其预后介于毛细胞性星形细胞瘤和弥漫浸润的星形细胞瘤之间,也就是1-2级.

 毛粘星在2000WHO就已经采纳，今年第四版WHO已经将其作为独立类型分出来了

最后诊断：黏液型毛细胞性星形细胞瘤（ pilomyxoid  astrocytoma）

WHO分型中毛细胞性星形细胞瘤为Ⅰ级。本型尚未归纳入WHO分类，文献报道其预后较普通毛细胞性星形细胞瘤差。

 翻译mjma老师的发言：

这是一例很不幸的浸润性星形细胞瘤，发生于延髓，局灶呈现胶质母细胞瘤样栅栏状结构。胶质母细胞瘤这一词我们已经不再使用。肿瘤细胞平行栅栏状排列不是某种肿瘤特定结构，可见于：毛细胞型星形细胞瘤、少突胶质细胞瘤、神经鞘瘤、脑膜瘤及子宫平滑肌瘤等。诊断时不应受其误导。栅栏状结构不明显的区域，梭形肿瘤细胞有中等程度细胞密度，有胶质细胞（星形细胞）分化的特点。尽管图中核分裂不清，象图7、8样的相对高的细胞密度， 在WHOⅡ级的星形细胞瘤不易见到。我相信如果仔细找，会见到核分裂的。Rosenthal纤维可以见到一、两处，但是不见嗜酸性小体、典型的双相生长方式（纤维、微囊区交替）或者其它毛细胞型星形细胞瘤的特点。而且MRI示浸润性的边缘，所以我诊断WHOⅢ级的 间变型星形细胞瘤 。肿瘤位于延髓，不易完全切除。不行放疗对该患儿很不利。预后不良。

 虽然没有看到明显的嗜酸性小体,但最后两张Rosenthal纤维似乎比较明显,虽然也没有看到明显的双相结构,但是黏液变性比较明显,以至于出现了"栅栏状结构"(可能与黏液变性有关),己见:

黏液型毛细胞星形细胞瘤

 颅内的肿物不是很好看,在这跟各位高手学习学习,从上图病理切片看,考虑良性肿瘤,神经鞘瘤,组织结构像神经上皮源性的肿瘤,细胞梭形,栅栏状排列,不一定正确,请高手指点

This is a sad case of infiltrating astrocytoma in medulla oblongata with an interesting spongioblastoma-like palisading pattern focally. Spongioblastoma is an old term that is no longer a valid to use nowadays. Specifically, the parallel palisades of neoplastic cells are not specific for a particular neoplasm, and can be seen occasionally in pilocytic astrocytomas, oligodendrogliomas, schwannomas, meningiomas, and rare uterine leiomyomas. One should not be preoccupied by this growth pattern during diagnostic interpretation. In areas where palisading is not apparent, there is spindle neoplastic cells with moderately high cellularity and features of glial (astrocytic) differentiation. Though I have not seen a good mitotic figure on the photos uploaded, the relatively high cellularity (Figures 7 and 8) is not that seen in WHO grade II astrocytoma. I am sure if examined carefully mitotic figures can be found in these areas. One or two possible Rosenthal fibers are seen, but I do not see good eosinophilic granular bodies or typical biphasic growth pattern (alternating fibrillary and microcystic areas) or other features of pilocytic astrocytoma. With MRI appearance of infiltrative border around the lesion, my diagnosis would be WHO grade III anaplastic astrocytoma. I don't think this neoplasm can be resected completely, being located in the medulla oblongata. Irradiation would be very harmful for the young child's brain. Prognosis is very guarded.