男 23岁  反复头疼2年，视力下降3月。MRI见颅内多发占位，右侧脑室及小脑幕下为主。

手术切除 右侧脑室及小脑幕下病变送检。

 肿瘤镜下可见3种不太一样组织形态。

诊断：1，脑膜瘤？

           2，PAX？

           3，室管膜下巨细胞星性细胞瘤?

           4，粘液乳头状型室管膜瘤?

            5,其他

There are normal choroid plexus fragments admixed with a meningioma that shows degenerative cytologic atypia and focal microcystic change. Some photos of meningioma show moderate cellularity and at least one prominent nucleoli. Grading of mkeningioma requires careful microscopic examination and mitotic counts, and photomicrographs will not allow for a definitive diagnosis. This is not papillary meningioma, chordoid meningioma, PXA or subependymal giant cell astrocytoma.

图12和19感觉不太像微囊，更倾向是脂肪化生，

诊断：化生型脑膜瘤（脂肪化生）或上皮型脑膜瘤，部分区域伴脂肪化生，伴脉络丛组织残留。

谢谢马老师！免疫组化标记PR\EMA\VIM\阳性；GFAP阴性；SYN那些大细胞为什么会是阳性表达?

I don't think you need to worry about synaptophysin-positive cells. This is meningioma, for sure.