象毛细胞性星形细胞瘤。

 同意楼上的意见

 脑膜瘤

 纤维样细胞、Rothens纤维和透明变性的血管

诊断：毛细胞性星形细胞瘤

 发生在小脑的肿瘤切除后九年复发，形态学上见梭形细胞增生，小血管透明变性，另见较多嗜酸性小体。如能多上传几张梭形细胞增生区域不同放大倍数的图片更佳。就目前几张图片来看，还是考虑低级别星形细胞瘤，毛细胞性星形细胞瘤可能性大。

Need to be very careful in handling this case due to previous surgery since reactive gliosis should be considered and rule out by immunostaining. Rothesal fibers can be seen in reactive process. another stain you may try is reticulin.  Final suggestion is send it for consultation.

Good luck.

 第一次术后做过放疗吗？考虑毛细胞星形细胞瘤。

This astrocytoma has many associated eosinophilic granular bodies and no dysplastic neurons. Therefore, I would consider recurrent pilocytic astrocytoma as the first diagnosis to rule out. If it is pilocytic astrocytoma, most cases are WHO grade I with rare atypical cases showing brisk mitotic activity. The photos seem to have been taken from suboptimal histologic preparation. Please try to have better sections for examination, and try to obtain previous material from 98 to examine and compare.

最后诊断；纤维型星形细胞瘤。
小脑纤维型星形细胞瘤，大多在小脑内局限且浸润性生长，瘤内常囊性变，可显示囊内附壁结节，光镜下瘤细胞均为分化较好的纤维型星形细胞，胶质纤维丰富，有微囊形成。可有玻璃样变的血管、泡沫细胞及淋巴细胞。

 本例最好有第一次的病理切片对照，就本次图片来看，觉得还是象复发性毛细胞型星形细胞瘤，一般来说，纤维型星形细胞瘤很少有嗜酸性小体的出现，而且血管透明变也少见，10年生存率还是比较低的。

 学习啦！

 毛细胞性星形细胞瘤

 I agree with "YOURSELF".

 

毛细胞性星形细胞瘤