间变

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

最后诊断：间变性少突胶质瘤

病理与临床特点

间变性少突胶质瘤(anaplasticoligodendroglioma,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。

Anaplasticolig火字开头的成语 odendroglioma(anaplasticoligoden

droglioma,AO)islessmalignantglioma,in2016theWHO

classificationbelongstodiffuastrocytesandoligodendrocytes

intumor,includingIDHmutationandNOS,classforⅢ,account

for25%~35%ofglialcellsinthetumorsandthe1%2%ofall

ominentgliomasareproneto

copically,therearesignsoflocalizedordiffu

malignancy,suchasdentumorcells,prominentnuclearatypia,

enlargednuclearplasmaratio,commoncysti治安管理处罚 cdegeneration,

necrosis,pudopalisadesoftumorcells,andprominenttumor

histochemicalstain男生爱你的表现 ing

significantlyincreadKi-67bymorethan7%-10%.Theageof

ontislessthan7-8yearsold,andtheageofontis45-50

nicalmanifestationsaresimilarto

tcommonsymptomsare

alrectionispreferredfor

treatment,chemotherapymaybeeffective,andradiotherapyis

poor

prognosiswithanaveragesurvivalof4years.

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)locati2副牌斗地主 onandmorphology:AOandoligodendroglioma

pronesitessimilar,alsowiththesupratentorial,especiallythe

frontallobeisthemostcommon,followedbythetemporallobe.

Tumorsmaycrossthemidlinethroughthecorpuscallosumand

emixeddensityor

signalbigbump,hematomaweekisoedema,haemorrhage,

ereobvioussignsof

occupation,suchaslocalgyrithickening,narrowfissionsinsulcus

andbrain,ventricularcompression,andcontralateralmigration

ofmidlinestructure.

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)CTshowedamixtureofequal,lowandhighdensity,

amongwhichthelowdensitycouldbethecystic/necroticarea,

thehighdensitycouldbethehemorrhageorcalcification,and

theperitumoredemacouldbethefingerlikelowdensity,which

couldinvadetheanteriorandposteriorlimbsoftheinnercapsule

andtheoutercapsule.

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;

(3)MRIshowedmixedsignalmass,T1WIwasdominatedby

equalandlowsignal,thecysticareawaslowersignal,perifocal

edemashowedfingerlikeorpatchylowsignal,bleedingwashigh

signal,andthesignaldidnotdecreaafterlipidcompression.

T2WIandFLAIRhavehyperintensity,bleedingandlow

calcification.

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,A小妹妹送我的郎 O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)CTandMRIenhancedscanswereenhancedtodifferent

degrees,andthesolidpartwanhancedobviously,whichwas

lumpy,patchy,annular,ydon'tintensify

ral,theAOenhancementratewas

62%~100%,whichwassignificantlyhigherthanoligodendyma.

Theenhancementdegreewasmoreobvious,andthetumor

1.30).

⑤功能成像:CBV可增高。MRS显示Cho峰及Cho/Cr明显增高

(后者>2.33)、NAA降低。T2*WI及SWI显示出血及钙化为低信号。

(5)Functionalimaging:wedthat

ChopeakandCho/Crincreadsignificantly(>2.33),andNAA

decread.T2*WIandSWIshowedlowsignalofhemorrhageand

calcification.

鉴别诊断

①少突胶质瘤,仅从影像学上难以与AO鉴别,前者水肿、囊变、坏

死及出血少见,而钙化较多见,MRS显示Cho峰及Cho/Cr较低,增强

T1WI对鉴别有一定价值,AO强化更明显,典型者为厚壁、不规则花环

状,但两者均可不出现强化,因此最终往往需病理学检查鉴别;

(1)gliomas,lesswithAOonimagingaloneisdifficultto

identify,edemaoftheformer,capsule,necrosisandhemorrhage

rare,andcalcificationismoree,MRSshowedlowerpeakand

ChoCho/Cr,enhancedT1WIofidentificationhasacertainvalue,

theAOstrengthenedmoreapparent,typ不幸的反义词 icalforthickwall,

irregularflowerring,butmaynotappearbothreinforcement,so

oftenendtopathologyinspectionidentification;

②少突-星形细胞混合胶质瘤及间变性星形细胞瘤或胶质母细胞瘤,

仅从部位、影像学征象上难以鉴别,常需病理学检查确定诊断。

(2)oligodendrogate-astrocytomamixedgliomaand

anaplasticastrocytomaorglioblastomaaredifficultto

distinguishonlyfromthesiteandimagingsigns,and免费注册个人邮箱

pathologicalexaminationisoftenneededtoconfirmthe

diagnosis.

简要讨论

间变性少突胶质瘤较少见,其特点为发病年龄较大,瘤周水肿、瘤内

坏死/囊变、出血较多见,而钙化较少,增强扫描肿瘤强化比増大,以不规

则环状较有特征,MRS显示Cho峰明显增高。但因其发病部位及形态

特点类似于更常见的少突胶质瘤,因此术前诊断有一定难度,需综合多种

征象甚至Ki-67才能定性诊断。

Anaplasticoligodendrogenicgliomaisrelativelyrare,

characterizedbyolderontage,moreperi-tumoredema,intra-

tumornecrosis语文阅读手抄报 /cysticdegeneration,andbleeding,andless

calcification,whichischaracterizedbyirregularringand

r,duetoits

locationandmorphologicalcharacteristicssimilartothemore

commonoligodendroglioma,preoperativediagnosisisdifficult,

andqualitativediagnosiscanonlybemadebyintegrating

multiplesignsandevenki-67.

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