伴神经毡岛样结构的胶质神经元肿瘤:一例报告并文献复习  

Glioneuronal tumor with neuropil-like island:a case report and review of literatures

作　　者：桂秋萍[1] 宋欣[1] 

机构地区：[1]解放军总医院病理科

出　　处：《中国现代神经疾病杂志》2009年第3期298-301,共4页Chinese Journal of Contemporary Neurology and Neurosurgery

摘　　要：目的探讨伴神经毡岛样结构的胶质神经元肿瘤的病理学特征。方法1例右侧顶枕部和胼胝体伴神经毡岛样结构的胶质神经元肿瘤（WHOⅡ～Ⅲ级）患者，HE染色和免疫组织化学染色行组织形态学观察和病理分析，并复习相关文献。结果大体标本观察肿瘤为灰白色破碎组织块，质地柔软，约3．00cm×3．00cm×0．50cm大小。组织形态学观察，肿瘤细胞呈界限分明的两种排列，一种为部分细胞呈圆形和卵圆形，异型性不明显，核分裂象少见，局部血管内皮细胞增生；部分细胞呈菊心团样结构，中心为神经毡岛样结构，肿瘤细胞呈广泛的“假栅栏状”排列，中心为神经毡岛样结构。另一种为肿瘤细胞呈“旋涡状”排列，伴钙化。免疫组织化学染色显示，神经毡岛样结构区域巢蛋白强阳性表达，神经元核抗原表达阴性，神经毡岛样结构周围部分细胞少突胶质细胞转录因子-2表达阳性，中心部位突触素强阳性表达；星形细胞瘤区域胶质纤维酸性蛋白表达阳性，p53阳性细胞数目为25％～50％；神经毡岛样结构区域Ki-67抗原标记指数〈5％，星形细胞瘤区域约为10％。结论伴神经毡岛样结构的胶质神经元肿瘤的生物学行为与浸润性星形细胞瘤相似，但“假栅栏状”结构与文献报道略有不同，可能与多个神经毡岛样结构融合有关。肿瘤染色体检测与星形细胞瘤相似，均表现为染色体7q、9p缺失，提示其本质-生物学行为仍为星形细胞源性而非神经元源性肿瘤.Objective To explore the pathological features of the glioneuronal tumor with neuropillike island （GTNI）. Methods The histomorphology and elinicopathology of one patient with GTNI （WHO Ⅱ -Ⅲ） at the right side of pariete-occipital lobe and corpus callosum were studied. HE staining and immunohistochemical staining were used for pathological analysis. Related literatures were reviewed. Results By gross anatomical examination the damaged pieces of tumor were soft greyish white in color and 3.00 cm × 3.00 cm × 0.50 cm in size. Under the microscope, the tumor cells presented 2 different well-defined arrangement patterns. In one part, some cells were round and oval in shape, with no distinctive atypia, less mitoses, and proliferation of regional vascular epithelial cells; some cells presented as rosette structure with neuropit-like island in the center, and the tumor cells were extensively arranged as ＂pseudopalisade＂ with neuropil-like island in the center. Another part of the tumor cells presented ＂whirl-like＂ arrangement with calcification. Immunohistochemical staining revealed that in neuropil-like island area, nestin expression presented strong positive and neuronal nuclei （Neu-N） expression presented negative, while some cells around the neuropil-like island expressed positive for oligodendroeyte lineage transcription factor-2 （Olig-2）, and synaptophysin （Syn） expression presented strong positive in the center. In astrocytoma area, glial fibrillary acidic protein （GFAP） expression presented positive, and the number of p53 positive cells was 25%-50%. In neuropil-like island area, the expression of Ki-67 antigen labelled index was less than 5%, while in astrocytoma area it was around 10%. Condusion The nature and biological behavior of GTNI are similar to infiltrating astrocytoma, but the presentation of ＂pseudopalisade＂ structure is something different with the description in literature reports. It may be related to the confluence of multiple neuropil-like islands. The tumo

关 键 词：肿瘤 神经上皮 中枢神经系统肿瘤 免疫组织化学 病理学 

分 类 号：R739.4[医药卫生—肿瘤]