第285课（中枢神经）病例探析间变性星形细胞瘤.pdfVIP

第285课（中枢神经）病例探析（079）—间变性星形细胞瘤 每次大家在阅读文章前，请花两分钟看看视频吧 一份公益，一份感动 女，49岁，头痛、头昏，右侧肢体麻木1月余 间变型星形细胞瘤 ( anaplastic astrocytoma)是弥漫浸润生长的 恶性星形细胞瘤,成年人多见,好发于大脑半球。肿瘤可由弥漫型星形细 胞瘤(WHOⅡ级)演变而来,或者无原始病变而直接形成,其良恶性分级为 WHOⅢ级,属于恶性肿瘤。 Anaplastic astrocytoma is a diffuse and infiltrating malignant astrocytoma. It is common in adults and usually occurs in cerebral hemisphere. Tumors can be made of diffuse astrocytoma (WHO Ⅱ) evolved, or without original lesions form directly, the benign and malignant class for the WHO Ⅲ, belong to malignant tumor. 间变型星形细胞瘤较胶质母细胞瘤和弥漫型星形细胞瘤少见 ,约占 全部颅脑肿瘤的 4%。但也有报道它的发病率略高于弥漫型星形细胞瘤, 约占全部胶质瘤的 25%。年龄和性别分布本病好发于 35 岁-55 岁的中 年人,男性患者略多。发生部位间变型星形细胞瘤与胶质母细胞瘤的发 生部位相同,好发于大脑半球,也可见于丘脑和桥脑,但是极少发生于小脑。 Mesenchymal astrocytoma is less common than glioblastoma and diffuse astrocytoma, accounting for about 4% of all brain tumors. However, its incidence is reported to be slightly higher than diffuse astrocytoma, accounting for about 25% of all gliomas. Distribution of age and sex the disease mainly occurs in the middle aged 35 -55 years old, male patients slightly more. The location of the astrocytoma is the same as that of the glioblastoma. The astrocytoma often occurs in the cerebral hemisphere, and can also be seen in the thalamus and pontine, but rarely in the cerebellum. 临床表现主要包括癫痫和局部定位症状。间变性星形细胞瘤临床 预后较差。间变性星形细胞瘤可以通过细胞外间隙和沿白质束扩散 ,也 可通过室管膜和脑脊液扩散。病理大体标本上可见肿瘤呈浸润性生长 , 与脑组织分界欠清,镜下可见局部细胞生长活跃伴异型性,细胞密度较高, 细胞核的非典型性与核分裂多见,血管内皮增生活跃,局部可见坏死。间 变性星形细胞瘤相对于低级别星形细胞瘤而言其细胞密度更高 ,细胞核 的非典型性与核分裂更突出。不同于胶质母细胞瘤的是间变性星形细 胞 瘤 缺 乏 典 型 的 血 管 增 殖 和 坏 死 。 免 疫 组 化 表 现 :MMP- 9(+),TopoII(++),EGFR(+),GFAP(+),PTEN(+)S100(+),EMA(+),VEGF( +)。与弥漫性星形细胞瘤相比,间变性星形细胞瘤 Ki-67 抗原标记指数 升高。 The clinical manifestations mainly include epilepsy and localized symptoms. The clinical prognosis of anaplastic astrocytoma is poor. Anaplastic a