中枢神经细胞瘤及非典型中枢神经细胞瘤12例临床病理观察  

Clinicopathologic analysis of central neurocytoma and atypical central neurocytoma

作　　者：崔华娟[1] 王卓才[1] 陈敬文[1] 彭大云[1] 赖日权[1] 

机构地区：[1]广州军区广州总医院病理科,广州510010

出　　处：《临床与实验病理学杂志》2013年第3期287-291,共5页Chinese Journal of Clinical and Experimental Pathology

摘　　要：目的探讨中枢神经细胞瘤(central neurocytoma,CNC)及非典型中枢神经细胞瘤(atypical central neurocytoma,ACNC)的临床病理特点。方法回顾性分析12例CNC的临床表现、影像学特点、组织学形态、免疫表型以及电镜特点,并对所有病例进行随访。结果 12例患者大部分表现为头晕、头痛等颅内压增高症状,少量伴神经功能障碍。组织学均表现为肿瘤细胞大小较一致,圆形,胞质少而略透明,其中散在无细胞区的神经毡样结构,间质血管呈纤细分支状,少数病例出现钙化。8例瘤细胞异型性小,未见坏死,核分裂象<2个/10 HPF,4例瘤细胞有异型,核分裂多见,>5个/10 HPF,其中2例见坏死。免疫表型:12例Syn弥漫阳性,NeuN则阳性强度不等。5例GFAP灶阳性,8例Ki-67增殖指数<2%,4例Ki-67增殖指数>8%。电镜观察瘤细胞胞质内可见神经内分泌颗粒,细胞间见突触结构。12例患者随访2个月～7年,其中2例复发,1例死于并发症,其余均无瘤生存。结论 CNC预后较好,组织学上易误诊为少突胶质细胞瘤、室管膜瘤,特别是ACNC易误诊为WHOⅢ级以上的肿瘤。免疫组化标记和电镜观察对鉴别诊断有重要作用。Purpose To study the clinicopathologic features of central neurocytoma and atypical central neurocytoma, and to improve the knowledge of central neurocytoma and atypical central neuroeytoma. Methods The clinical manifestations, image, histopathologi- ca] features, immunohistochemieal and electron microscope were analyzed in twelve cases central neurocytoma, and all cases were fol- lowed up. Results The most common presenting symptoms were those related to increased intracranial pressure （ ICP）, including headache and swirl, few cases accompany with nerve disfunction. Histologically, all tumors composed of uniform medium-sized clear round cells with small neuropil-like structure. The blood vessel of stroma were slight and ramified, calcification could be seen in few cases. Atypia and necrosis could been seen in eight cases and mitoses were less than 2 per 10 high power field. Four cases have tumor cell atypia and mitoses were more than 5 per 10 high power field, necrosis could been seen in two of four cases. Immunohistochemical- ly, the tumor cells of twelve cases were positive for synaptophysin and NeuN had different degree positive. Focally positive for GFAP was seen in five cases. MIB-1 index entirely was less than 2% in eight cases and more than 8% in four cases. Electron microscopic in- vestigation showed there were neuroendocrine granules in the cell cytoplasm and synapses between tumor cells. After two months to sev- en years follow-up, two cases recurred and one case died due to postoperative subsequent symptom, the other cases were all alive with- out tumors. Conclusion Central neurocytoma have a favorable prognosis in general, which is difficult to be distinguished histopathogi- eally from oligodendroglioma and ependymoma. Atypical central neurocytoma could easily been mistaken for WHO II grade tumor espe- cially. Immunohistochemical and electron microscope were very important for diagnosis.

关 键 词：中枢神经细胞瘤 非典型 预后 临床病理 

分 类 号：R739.4[医药卫生—肿瘤]