胶质肉瘤的影像表现与病理特征分析  

Gliosarcoma Imaging Features and Pathologic Analysis

作　　者：康晓伟[1] 卫一宾 唐兴[1] 印弘[1] 魏光全[1] 

机构地区：[1]第四军医大学西京医院放射科,西安710032

出　　处：《临床放射学杂志》2017年第8期1079-1083,共5页Journal of Clinical Radiology

摘　　要：目的探讨胶质肉瘤的影像表现和病理学特征。方法回顾性分析13例胶质肉瘤患者的临床和影像学资料,并分析其病理学特征。结果 13例胶质肉瘤均为幕上单发肿块,多跨脑叶生长。12例为原发性,1例继发性。囊性伴壁结节1例,囊实性3例,实性为主7例,完全实性1例,其他类型1例。6例实性为主胶质肉瘤呈脑膜瘤样外观,位于大脑凸面,瘤周水肿轻或无;1例实性为主和3例囊实性胶质肉瘤呈胶质母细胞瘤样外观。CT可见4例伴出血,MRI增强可见4例脑膜侵犯,其中1例破坏颅骨。光镜所见肿瘤细胞部分为圆形、肥胖形或多形性细胞弥漫排列,部分为胶原纤维样基质内梭形细胞不规则束网状排列,部分可见骨组织分化。免疫组织化学染色IDH1 R123H为阴性(3/3),1p/19q无杂合性缺失(2/2),其中1例IDH基因测序阴性。Ki-67增值指数15%~75%,平均43%。结论胶质肉瘤以间叶成分为主时,影像学表现具有一定的特征性,但确诊仍有赖于病理检查。Objective To summarize the imaging and pathologic features of gliosarcoma. Methods The clinical characteristics,imaging and pathological features of 13 cases with histologically confirmed gliosarcoma were retrospectively analyzed. Results All of the gliosarcomas were supratentorial single masses with infiltrative growth across the brain lobes.All patients were diagnosed with primary gliosarcoma,except 1 secondary gliosarcoma. Among all,1 lesion appeared as a large cyst with a small mural nodule; 3 lesions were cystic and solid masses; 7 lesions were predominantly solid masses; 1 lesion was a completely solid mass; 1 lesion was the other type. Patients with gliosarcomas resembling meningioma features were mainly the solid mass type（ 6/13）,which were located in the peripheral region and had no or mild peritumoral edema. Patients with gliosarcomas resembling glioblastoma multiforme features were mainly the solid or cystic-solid mass type（ 4/13）. Hemorrhage was noted in 4 cases. Meningeal breach was noted in 4 cases（ 4/6） and 1 case had skull destruction. Histopathological analysis revealed that some tumor cells were diffusible arranged in round,gemistocytic and pleomorphic cells,while the other parts were spindle cells in the stromal collagen fibers and arranged by irregular beam mesh,with partial osseous differentiation. With immunohistochemistry result,3 cases expressed IDH1 R123 H. 2 cases had no codeletion 1p/19 q and 1 case had no IDH mutation. Ki-67 value ranged from 15% to 75%,with the average of 43%. Conclusion Gliosarcoma containing more mesenchymal tissue has haracteristic manifestations. However,the final diagnosis still depends on the histopathological examination.

关 键 词：胶质肉瘤 影像学表现 病理 

分 类 号：R445.2[医药卫生—影像医学与核医学] R730.44[医药卫生—诊断学] R739.41[医药卫生—临床医学]