第三脑室脊索样胶质瘤影像学表现及鉴别诊断:附3例报道及文献复习  

Chordoid glioma in the third ventricle:image findings and differential diagnosis:a report of three cases and review of the literature

作　　者：汪文胜 方进[2] 周全[2] 陈燕萍[3] 成丽娜 吴静 黄泽春 

机构地区：[1]广东三九脑科医院影像中心,广州510510 [2]暨南大学附属第一医院医学影像中心,广州510630 [3]南方医科大学附属南方医院医学影像中心,广州510515

出　　处：《磁共振成像》2016年第10期749-753,共5页Chinese Journal of Magnetic Resonance Imaging

摘　　要：目的 探讨CT及MRI对第三脑室脊索样胶质瘤的诊断价值。材料与方法 收集经病理证实的3例第三脑室脊索样胶质瘤患者,年龄7～34岁,男2例,女1例;3例均行MRI检查,其中2例行CT检查;总结其临床、影像学表现及病理资料,并复习相关文献。结果 临床表现主要为梗阻性脑积水、头痛及神经内分泌紊乱症状。CT及MRI上肿瘤均位于第三脑室,并幕上脑室系统积水、扩张。CT多表现为体积较大的低密度肿块,密度均匀,边界清楚,未见囊变或坏死,钙化少见（仅1例见病灶边缘钙化）。MRI上肿块信号均匀,T1WI均呈低信号,T2WI均呈明显高信号,增强扫描2例呈显著不均匀强化,另1例呈显著均匀强化。病理学表现为肿瘤细胞成簇或散在分布在黏液样基质中,细胞疏密不等。瘤细胞核圆形、类圆形或偏位,染色质呈颗粒或凝块状,细胞核小、深染,核分裂少见,伴微囊形成,无坏死,可有小血管增生。免疫表型示所有瘤细胞均表达胶质纤维酸性蛋白（glial fibrillary acidic protein,GFAP）和波形蛋白（vimentin）。结论 第三脑室脊索样胶质瘤影像表现具备一定特征性,结合临床表现可作出诊断,最终确诊需要根据病理及免疫组化检查。Objective： To summarize the CT and MRI findings and differential diagnosis of chordoid glioma in the third ventricle and to explore the diagnostic value of imaging examination. Materials and Methods： Three patients （two males and one females; range, 7-34 years） with chordoid glioma in the third ventricle confirmed by biopsy pathology were enrolled. The symptoms, imaging findings and pathology were retrospectively analyzed, and then a review of the literature was performed. Results： The symptoms were usually obstructive hydrocephalus, progressive headache, neuroendocrine symptoms. All the three tumors located in the third ventricle. The tumor usually represented as a large, well-circumscribed ovoid and hypodense lesion on CT. No cystic or necrotic changes were found. Only one case had peripheral calcification, as hyperdense on CT. On MRI, the lesions all showed homogeneous hypointensity on Tl-weighted image and hyperintensity on T2-weighted image. Two cases showed heterogenously enhancement, while the other one showed homogeneously enhancement. Microscopically, the tumor cells arranged in clusters or scattered in a mucinous background. Tumor cell nucleus were round, oval or offset, chromatin were granulated or nubby, the nuclei were small and hyperchromatic, nuclear fission were rare. Necrosis was not identified, new blood vessels showed proliferation. Immunohistochemically, tumor cells were stained positively for GFAP and vimentin. Conclusion： There are several characteristic CT and MRI findings of chordoid glioma in the third ventricle. The diagnosis can be made when combining image findings with clinical findings. The final diagnosis should be confirmed by histopathology and immunohistochemical staining.

关 键 词：脊索样胶质瘤 第三脑室 磁共振成像 体层摄影术 X线计算机 

分 类 号：R445.2[医药卫生—影像医学与核医学] R739.41[医药卫生—诊断学]