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- 右侧小脑肿物！
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This is not an easy case to interpret. The cerebellar cortex and subcortical white matter are abnormal in loss of Purkinje cells, perivascular cuffing by lymphoplasmacytic cells (Figure 2), formation of many Rosenthal fibers (Figures 3~4) and possible parenchymal necrosis associated with gliosis (Figures 6 and 8). I do not see hypercellularity or cytologic atypia suffient for the diagnosis of a neoplasm, and the features are not diagnostic of a vascular malformation, either. Rosenthal fibers can be formed in brain parenchyma adjacent to various lesions, including infarction and space occupying lesions of different nature (including neoplasms). They have been associated notoriously with WHO grade I pilocytic astrtocytomas and craniopharyngiomas, but can be found in WHO grade I~II gangliocytomas/gangliogliomas and rare cases of diffuse infiltrating astrocytomas. I suspect the photos reflect tissue reaction adjacent to the target lesion, which could be an infectious/inflammatory process (cerebellitis), a low-grade neoplasm, an old infarct, or (less likely and easily corroborated by clinical history) a remote traumatic injury. Correlation with pre- and post-surgical MRI to be certain that target lesion was resected is important. It is always difficult to convince neurosurgeons that they missed the lesion.
聞道有先後,術業有專攻
根据楼主的需要我翻译了马老师的帖子，帖子写的很好，分析到位，对我启发很大，什么事情都可能发生。除了我们的原因外，我还没有想过外科医生会取不到病变实质的问题。受益非浅。
本例提供的图片以难确立诊断，（图二）显示小脑皮质及皮质下白质的Purkinje细胞异常地消失，并且有血管旁袖套状淋巴细胞浸润，以及形成Rosenthal氏纤维（图三、四），可能有脑实质的坏死及胶质细胞增生（图六和八）。我没有见到有足够的细胞数目及细胞的异形性可以确诊为肿瘤。但是这些特点也不能确认其为血管畸形。Rosenthal 氏纤维的形成可见于脑实质病变附近，这些病变可以是多种疾病，包括脑梗塞，各种占位性病变（也包括肿瘤）。Rosenthal 氏纤维的形成可见于著名的WHO分类中I 毛细胞性星形细胞瘤，鼻咽血管瘤，也见于I~II节细胞瘤/节细胞性胶质瘤。但是罕见于弥漫浸润性星形细胞瘤。
我考虑本例所提供的图片是一组病变旁的反应性改变，本病的本质应该是一种感染/炎性过程（脑炎），或者是低度恶性之肿瘤，也可能是一种陈旧性的脑梗塞，如果认真了解病史或许是一种老的创伤。结合术前术后的核磁共震，看一看是不是真的切除了病变也很重要，有时外科医生切错病变也不算稀罕。
