图11、12、13分别为IHC：Syn、GFAP、S-100。图14为Bielschowsky 染色

The photos show a fairly cellular neoplasm consisting mainly of relatively uniform cells with oval nuclei and occasional mitoses. Formation of perinuclear halos is seen focally, but no characteristic delicate capillaries, mucinous microcysts, minigemistocytes or calcification are noted. I think this is a glioma, more likely an astrocytoma than an oligodendroglioma or ependymoma. If so, the cellularity and mitosis seen are that of WHO grade III anaplastic astrocytoma. However, I cannot rule out oligodendroglioma (WHO grade II or III) without looking at more representative areas. I don't think this is neurocytoma or neuronal tumor.

 翻译：   图片显示肿瘤细胞丰富，大小相对一致，核卵圆，可见核分裂。局灶可见细胞核周空晕，但是没见到典型特征性的纤细的血管、粘液微囊或钙化。我考虑是神经胶质瘤，首先是星形细胞瘤，其次是少突胶质细胞瘤或室管膜瘤。富于细胞、可见核分裂，支持分化不良星形细胞瘤（间变型星形细胞瘤）（WHO grade III ）。当然，应该寻找病变的典型区域，除外少突胶质细胞瘤（(WHO grade II or III）。不考虑神经细胞瘤或神经元肿瘤。

 最后诊断：中枢神经细胞瘤（central neurocytoma）

诊断要点：

1.肿瘤细胞大小一致，核圆形规则，染色质点彩状，核仁不明显，核分裂象罕见，本例可见一个核分裂象。

2.部分细胞核周空晕较明显呈蜂窝状，似少枝胶质细胞瘤。

3.细胞间由分支的毛细血管网分隔成巢状。有时可见到特征性的无细胞核的基质岛，由纤细的神经原纤维构成，多呈星状，边缘不太规则，外周有肿瘤细胞围绕，并可见到单排或多排的肿瘤细胞呈溪流样流入基质岛。本例未显示。

4.常常可见微小钙化。本例未见。

鉴别诊断：

1.少枝胶质细胞瘤

2.室管膜瘤

3.PNET

 完整而准确的诊断应该是: 脑室外非典型神经细胞瘤.

 学习了