第246课（中枢神经）病例探析（069）—间变性少突胶质瘤
男，66岁，突发头痛伴2月余
黑椒汁
股东的权利和义务
司法鉴定机构最后诊断：间变性少突胶质瘤
介绍中秋节病理与临床特点
间变性少突胶质瘤( anaplastic oligoden droglioma,AO)即恶性少突胶质瘤,2016年 WHO 新分类中属于弥漫性星形细胞与少突胶质细胞肿瘤,包括 IDH 突变型与 NOS型,分级为Ⅲ级,占胶质细胞肿瘤的25%~35%及所有原发脑肿瘤的 1%-2%。较少突胶质瘤易出现坏死。镜下可见局限性或弥漫性恶性肿瘤征象,如肿瘤细胞密集、核异型性明显、核浆比増大,常见囊变、坏死及肿瘤细胞假栅栏状排列,肿瘤微血管增生明显。免疫组织化学染色 Ki-67明显增高,超过7%-10%。发病年龄较少突胶质瘤大7-8岁,好发年龄为45~50岁。临床表现与少突胶质瘤近似,最常见的症状为抽搐与头痛。治疗首选手术切除,化疗可能有效,放疗用于治疗肿瘤残留与复发。AO 预后欠佳,平均生存期为4年。
Anaplastic oligoden droglioma (anaplastic oligoden droglioma, AO) is less malignant glioma, in 2016 the WHO classification belongs to diffu astrocytes and oligodendrocytes in tumor, including IDH mutation and NOS, class for Ⅲ, account for 25% ~ 35% of glial cells in the tumors and the 1% 2% of all primary brain tumors. Less prominent gliomas are prone to necrosis. Microscopically, there are signs of localized or diffu malignancy, such as den tumor cells, prominent nuclear atypia, enlarged nuclear plasma ratio, common cystic degeneration, necrosis, pudopalisades of tumor c
ells, and prominent tumor microvascular hyperplasia. Immunohistochemical staining significantly incread Ki-67 by more than 7%-10%. The age of ont is less than 7-8 years old, and the age of ont is 45-50 years old. The clinical manifestations are similar to oligodendroglioma. The most common symptoms are convulsion and headache. Surgical rection is preferred for treatment, chemotherapy may be effective, and radiotherapy is ud to treat tumor residue and recurrence. AO has a poor prognosis with an average survival of 4 years.
阴瑜伽CT与 MRI 特点
①部位及形态:AO 与少突胶质瘤好发部位类似,也以幕上、特别是额叶最常见,颞叶次之。肿瘤可经胼胝体越过中线侵犯对侧大脑半球。常为混杂密度或信号的大肿块,瘤周水肿、出血、囊变均较常见。占位征象明显,如局部脑回增粗、脑沟及脑裂变窄、脑室受压,以及中线结构向对侧移位;
(1) location and morphology :AO and oligodendroglioma prone sites similar, also with the supratentorial, especially the frontal lobe is the most common, followed by the temporal lo
夸人的词语女生be. Tumors may cross the midline through the corpus callosum and invade the contralateral hemispheres. Often be mixed density or signal big bump, hematoma week is oedema, haemorrhage, cystic change are more common. There were obvious signs of occupation, such as local gyri thickening, narrow fissions in sulcus and brain, ventricular compression, and contralateral migration of midline structure.
②CT 呈等、低及高密度混杂,其中低密度可为囊变/坏死区,高密度为出血或钙化,瘤周水肿为指状低密度,可侵犯内囊前后肢及外囊;
(2) CT showed a mixture of equal, low and high density, among which the low density could be the cystic/necrotic area, the high density could be the hemorrhage or calcification, and the peritumor edema could be the fingerlike low density, which could invade the anterior and posterior limbs of the inner capsule and the outer capsule.
③MRI 呈混杂信号肿物,T1WI以等及低信号为主,囊变区为更低信号,灶周水肿呈指状或斑片状低信号,出血为高信号,压脂后信号不下降。T2WI及 FLAIR以高信号为主,出血及钙化低信号;
什么是非遗(3) MRI showed mixed signal mass,T1WI was dominated by equal and low signal, the cystic area was lower signal, perifocal edema showed fingerlike or patchy low signal, bleeding was high signal, and the signal did not decrea after lipid compression. T2WI and FLAIR have hyperintensity, bleeding and low calcification.
创建卫生城市④CT与MRI 増强扫描呈不同程度强化,实性部分强化明显,呈块状、斑片状、环形,以环状为主。但也可不岀现强化。总的来说,AO 强化率为 62%~100%,明显高于少突胶质瘤。且强化程度更明显,肿瘤增强比大(如1.30);
(4) CT and MRI enhanced scans were enhanced to different degrees, and the solid part was enhanced obviously, which was lumpy, patchy, annular, mainly annular. But they don't intensify immediately. In general, the AO enhancement rate was 62%~100%, which was significantly higher than oligodendyma. The enhancement degree was more obvious, and the tumor enhancement ratio was larger (e.g. 1.30).
