右侧丘脑恶性颅咽管瘤临床及病理特点

目的:报道1例原发于右侧丘脑的颅咽管瘤7年后肿瘤局部转化为鳞状细胞癌的病例,并探讨颅咽管瘤的恶变的相关病理。方法:对病例7年前及此次临床资料参阅MRI表现进行对比,对2次手术组织采用常规石蜡切片,并对第二次手术组织进行p53、Ki-67免疫组织化学染色,光镜观察。结果:两次肿瘤部位相同,7年前(2000年)组织镜下可见大量良性的鳞状上皮及角化物,未见明确造釉上皮成分,细胞无异型性,此次组织镜下见较多造釉上皮成分及鳞状上皮成分,部分鳞状上皮分化良好,局部可见少量角化珠,细胞密集区核大深染,异型性明显,核分裂像多见,并可以看到与正常鳞状上皮之间的移行,为明确的鳞状细胞癌。结论:恶性颅咽管瘤极为罕见,此类病例被认为是放疗引起颅咽管瘤的恶变,但有待于大样本的病例去证实。

Clinical and pathologic features of malignant craniopharyngioma of the right thalamus

Ojbective: To report a case of craniopharyngioma of malignant transition in the right thalamencehpalon after the radiotherapy and discuss the mechanism of this change.Methods: We reviewed the clinical features and MRI.The specimen of the resected tissue was examined using routeine tissue slices with hematoxylin and eosin staining.Immunostaining was performed to detect the expression of p53 and Ki-67.Results: The tumors of the two times were in the same anatomic site.The tissue section submitted from the previous resections in 2000 for histologic examination were reviewed.We could see the majority of the tumor was keratinization and some benign squamous epithelium and there was no ameloblast component in all the section.But in the 2007 section,There were typical areas of squamous cell carcinoma and the transition from the benign squamous epithelium to the squamous cell carcinoma.Conclusion: Malignant craniopharyngiomas are distinctly rare tumors.We believe that the cause of malignant change in this case is the radiotherapy,but the relationship between malignant change and radiotherapy is still need more cases to be confirmed.