非常好的病例！谢谢zhang老师！组织学上两个特点：一是两种主要细胞，小细胞+胖细胞；一是血管透明变明显，部分区域小细胞围绕血管生长。请zhang老师告知病人年龄，性别，肿瘤具体位置，影像学特点。谢谢！

以下是引用yourself在2008-3-6 21:27:00的发言：  非常好的病例！谢谢zhang老师！组织学上两个特点：一是两种主要细胞，小细胞+胖细胞；一是血管透明变明显，部分区域小细胞围绕血管生长。请zhang老师告知病人年龄，性别，肿瘤具体位置，影像学特点。谢谢！

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恶性横纹肌样脑膜瘤 

 从影像学及组织学上看，首先考虑横纹肌样脑膜瘤，需免疫组化（EMA，Vim，GFAP，Nestin，NeuN，CK，PR）除外室管膜瘤及胶质或胶质神经元混合性肿瘤。

 恶性横纹肌样脑膜瘤

This is not an easy case to interpret. Each time I looked at the photos I got some different impression. The neoplasm consists of very loosely arranged cells between large hyalinized blood vessels and amianthoid fibers. The first low power view suggests there is pseudopalisaded tumor necrosis, but high power views do not really confirm necrosis in the loose areas. Though no definite meningothelial whorls or psammoma bodies are seen, there are solid nests of epithelial looking neoplastic cells (especially on photos containing amianthoid fibers) to suggest a meningioma. Was there a history of presurgical embolization of the tumor by an interventional radiologist (which may cause acute infarction with discohesive cells)? MRI images do suggest dural attachment with an enhancing tail, but this does not exclude a surface glioma that adhere to dura. The cellularity is focally very high, suggesting that this is not a benign neoplasm. However, I failed to find mitosis on these uploaded photos. There is prominent perivascular radial arrangement of neoplastic cells, and the loose areas are rimmed by condensed neoplastic cells. It's not an easy case to diagnose without thorough microscopic examination and immunohistochemical stains. My differential diagnoses include meningioma (favored) and glioma. Though the prominent perivascular arrangement and hyalinized blood vessels suggests ependymoma, I would like to see whether the neoplastic cells are uniform or not. Certainly no ependymal canals are seen. If the loose areas are indeed necrosis and mitoses can be found readily with some or much cytologic variation, this would be a WHO grade IV glioblastoma. If cells are fairly uniform without clearcut necrosis, this may be a WHO grade II ependymoma or WHO grade I meningioma. As for the plump epithelioid cells with eosinophilic cytoplasm, I suspect they are just aberrant epithelial differentiation or degenerative change. I do not think this is rhabdoid meningioma. Cells in rhabdoid meningioma are different from the plump eosinophilic cells shown here. Immunohistochemical stains with GFAP, EMA, PR and MIB-1 may help. Interesting case!

 meningioma(WHO grade I)

This is a WHO grade I meningioma. The areas containing loose neoplastic cells can be very misleading. As much as we rely on immunohistochemical stains nowadays, a good HE section is still very valuable.

 可以见到明显的横纹肌样细胞,我想请教马老师本例属于何种类型的脑膜瘤

以下是引用wy1992在2008-3-13 12:05:00的发言：  可以见到明显的横纹肌样细胞,我想请教马老师本例属于何种类型的脑膜瘤

"As for the plump epithelioid cells with eosinophilic cytoplasm, I suspect they are just aberrant epithelial differentiation or degenerative change. I do not think this is rhabdoid meningioma"

 谢谢张老师!