5年前进修时看过许多脑肿瘤，回来后再也没见过一例。现在脑外建科，这是本院史上第一例开颅取肿瘤手术，可惜我已经把5年前的本事忘了。请老师详细指点，谢谢！ 

 间变性星形细胞瘤WHO  III级

肿瘤组织大部分由胞浆淡染，境界清楚的肿瘤细胞组成，细胞异型性明显，间质较丰富，可见出血及坏死，考虑为间变性少突胶质细胞瘤，鉴别诊断为胶质母细胞瘤，免疫组化标记OLIG－2可能有帮助。

 少突胶质细胞瘤，或神经中枢细胞瘤，应结合影像学与免疫组化进行鉴别。免疫组化做GFAP, OLIG-2,  NSE,  SYN等

 谢谢老师，我起初认为是星型细胞瘤II级。

 The DDx in this location may include central neurocytoma, sub-ependymoma and others, need immunostains to work up.

Good case and thanks.

 Glioneuronal Tumor with a pilocytic astrocytic component

间变性少突胶质细胞瘤

 Other points supporting the central neurocytoma.

Central neuricytoma favors left ventricle (location x 3)

it has some morphology similar to oligo, but remember oligo would not happen inside ventricle (location x 3)

Hope your immunostain helps.