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- 右侧颞顶叶肿瘤
| 以下是引用mjma在2010-7-16 7:06:00的发言： The photos are certainly consistent with WHO grade IV glioblastoma. However, most neoplastic cells shown (except for the pseudopalisaded bands around necrotic areas) have relatively uniform oval nuclei suggestive of oligodendrocytic differentiation. One has to examined carefully for any oligodendroglioma component to rule out (1) WHO grade IV glioblastoma with an oligodendroglioma component, (2) WHO grade III anaplastic mixed oligoastrocytoma, and (3) WHO grade III anaplastic oligodendrogkioma. These three diagnoses have overlapping features and distinction between them can be very subjective. |
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The photos are certainly consistent with WHO grade IV glioblastoma. However, most neoplastic cells shown (except for the pseudopalisaded bands around necrotic areas) have relatively uniform oval nuclei suggestive of oligodendrocytic differentiation. One has to examined carefully for any oligodendroglioma component to rule out (1) WHO grade IV glioblastoma with an oligodendroglioma component, (2) WHO grade III anaplastic mixed oligoastrocytoma, and (3) WHO grade III anaplastic oligodendrogkioma. These three diagnoses have overlapping features and distinction between them can be very subjective.
聞道有先後,術業有專攻
首先考虑胶质母细胞瘤。
以下类型鉴别：
1）胶质母细胞瘤：成人多发，40-60岁高发，可发生于脑任何部位。影像学显示膨胀性生长伴特征性环状增强影和瘤体内部信号不均。大体和镜下见肿瘤周边浸润性生长。组织学最具有特征的是：血管内皮外皮增生+灶性地图状坏死+坏死灶周围梭形胶质母细胞栅栏状或假栅栏状排列。本例可见到这样的栅栏状排列的图像，其中央可见小灶坏死。瘤细胞分化比较差，易见核分裂。这些支持胶质母。然而，有的假栅栏状排列的中央是血管或结缔组织，有血管周围假花环结构，血管内皮外皮细胞增生不是特别突出。所以需要多些视野看片识别。
2）间变性室管膜瘤：本例最需要鉴别的是间变性室管膜瘤。该瘤特征：核多形性明显+大量核分裂+细胞密度较高，以及血管轴心的假花环瘤细胞排列结构（或肾小球样结构）+坏死。可有血管内皮增生。
3）间变性星形细胞瘤：复发性间质瘤病例中常见，也可始发。影像学显示瘤组织信号不均，灶性增强，肿瘤界限不清。组织学显示瘤细胞呈中-高度多形性，纤细的血管网。按照WHO标准，其特征是：瘤细胞密度呈灶性或弥漫性增加+核异型性+多见核分裂，缺乏坏死和血管内皮增生（必备诊断条件）。本例有坏死。不符合间变性星形细胞瘤。然而，间变性星形细胞瘤可进展为胶质母细胞瘤。
4）间变性少突胶质细胞瘤：本例细胞密度中等的区域，可见瘤细胞核周胞浆透亮，因此也是需要鉴别的。该瘤主要特征：少突胶质瘤细胞特点+间变性特点（细胞密度高+核分裂易见+核异型性大+坏死+内皮明显增生）。可形成血管轴心的乳头状结构或肾小球样结构。肾小球样结构中内皮外皮细胞显著增生，是少突胶质细胞瘤鉴别的主要标志。提供的现有图片看，没有见到这样的结构。
5）PNET：可以IHC标记鉴别。
- 王军臣
