Intraoperative squash cytology of central nervous system lesions: a single center study of 326 cases

Cytology has been shown to be of great value in intraoperative consultations of central nervous system (CNS) pathology. Intraoperative smear cytology provides a rapid and reliable intraoperative diagnosis and guidance to the neurosurgeon during surgical resection and lesion targeting. It also helps the surgeon to monitor and modify the approach at surgery. The current study was undertaken to assess the accuracy and utility of intraoperative consultations for cytomorphological diagnosis by smear technique and correlate with histopathological diagnosis. A retrospective study of 326 cases of CNS intraoperative consultations was performed. Smears were prepared from the biopsy samples sent in isotonic saline for immediate processing and stained by the Haematoxylin and Eosin method. The cytomorphological features were noted and correlated with final histopathological diagnosis. Concordance between the intraoperative diagnosis and the final diagnosis was seen in 83.7% of cases. We demonstrated >95% accuracy for glioblastomas and >89% accuracy for meningiomas and schwannomas. A reduction of diagnostic accuracy was seen in oligodendrogliomas (60%) and anaplastic oligodendrogliomas (57.2%). Smear technique is a fairly accurate, relatively safe, rapid, simple, easily reproducible, and cost effective tool to diagnose brain tumors. Smear cytology is of great value in intraoperative consultation of CNS pathology.     

颅内乳头状肿瘤的免疫组化研究

颅内乳头状肿瘤是一组病理学易于误诊的疾病。本文对22倒颅内乳头状肿瘤。选用8种抗体标记。转移性乳头状脓癌以CEA最有诊断价值。乳头状室管膜瘤和乳头状胶质母知胞瘤以GFAP、S-100、Vimentin阳性为主,Keratin阳性率很低,乳头上皮细胞下无Ⅳ型胶原和Laminin阳性基底膜物质。相反脉络丛乳头状肿瘤Keratin阳性率高,GFAP和Virnentin阳性率低,乳头上皮下有Ⅳ型胶原和Laminin标记阳性的基底膜物质。乳头状脑膜瘤虽有双相分化,但免疫标记以Vimentin阳性为主,Keratin和EMA反应很弱,其它标记则为阴性。乳头状垂体腺瘤对本组抗体大多呈阴性反应。     

Accuracy of the smear technique in the cytological diagnosis of 650 lesions of the central nervous system

The authors analyzed the results of 650 lesions of the central nervous system submitted to intraoperative cytological diagnosis by the smear technique. Cytological and paraffin section diagnoses were compared. The following statistical values were obtained: accuracy of 97.3%, sensitivity of 97.9%, specificity of 95%, positive predictive value of 99.1%, and negative predictive value of 89.6%. The authors comment on their main pitfalls using this cytological diagnostic procedure.     

Granular cell tumor of the neurohypophysis: report of a case with intraoperative cytologic diagnosis

Cytological techniques including touch and smear preparations are very useful diagnostic modality in the evaluation of central nervous system (CNS) lesions and, in many instances, may be effectively used as the sole modality of tissue preparation for intraoperative consultation. Cytologic preparations offer many advantages over frozen sections for CNS specimens. These include selective examination of multiple areas from small biopsy specimens, superior preservation and details of cellular morphology, fewer artifacts, faster results, and improved cost-effectiveness. We describe the cytologic diagnosis of a granular cell tumor (GCT) of the neurohypophysis in a 33-year-old male who presented with headache and blurred vision. CT scan revealed an enlarged sella with a 2.15 x 2.0 cm pituitary lesion. Transsphenoidal resection of the mass was performed and submitted for intraoperative consultation. Smears and touch preparations were made on a portion of the mass that showed uniform polygonal cells with round to ovoid nuclei and abundant eosinophilic granular cytoplasm. An intraoperative cytological diagnosis of "favor GCT" was rendered. The histologic sections of the remaining material confirmed the diagnosis. Although GCT of the neurohypophysis is very rare, a specific intraoperative cytological diagnosis is possible. We report the clinical, cytological, and pathological findings of a GCT affecting the neurohypophysis.     

颅内胶质母细胞瘤51例临床病理分析

目的 回顾性分析51例胶质母细胞瘤临床病理特征、免疫表型、影像学特点、诊断及鉴别诊断.方法 对51例胶质母细胞瘤标本进行临床资料统计,应用HE染色、免疫组化等方法进行病理学特征观察,CT和MR检查分析其影像特点.结果 胶质母细胞瘤临床表现主要为头晕、头痛、呕吐,CT和MR检查示颅内界限不清的占位性病变,常伴有出血、坏死和囊性变,增强扫描呈不规则环状强化.肿瘤组织学显示瘤细胞弥漫分布,异型性明显,血管明显增生,伴有出血和坏死,坏死灶周围瘤细胞常排列呈栅栏状.免疫组化显示GFAP和vimentin均呈强弱不等的阳性,Ki-67表达较高,阳性细胞数平均为28.94%,而其它标记物的表达不尽相同.结论 胶质母细胞瘤来源于星形细胞,组织形态具有一定的特征性,在颅内肿瘤中恶性程度最高,预后差.其影像学表现与肿瘤的病理改变密切相关.特殊类型的胶质母细胞瘤须注意与胶质肉瘤、恶性神经节细胞胶质瘤等相鉴别.     

颅内生殖细胞瘤适形调强放射治疗及剂量学研究

目的应用半野和适形调强全脑全脊髓放射治疗技术治疗颅内生殖细胞瘤,评价其疗效及毒性反应。方法 12例颅内生殖细胞瘤患者,其中男性10例,女性2例;年龄15～28岁,中位年龄21岁。给予CT模拟定位,采用半野和适形调强放射治疗技术治疗,全脑全脊髓的放射治疗剂量为25.2 Gy（14次）,肿瘤病灶的放射治疗总剂量为45 Gy（25次）,每天每次1.8 Gy,5次/周,治疗后及随后每3个月评价1次疗效,随访时间为1～60个月,中位随访时间36个月。结果放射治疗结束后评价,完全缓解11例,部分缓解1例,近期临床受益率为100%。除1例失访外,其余11例均生存。放射治疗剂量学研究：经适形调强优化后的技术剂量分布优于常规定位技术,定位时间明显缩短[（8.83±1.55）s vs（40.8±2.4）s]。结论半野技术结合适形调强放射治疗技术治疗颅内生殖细胞瘤,优化了放射治疗剂量学,操作方便,疗效好,并发症少。     

颅内多发病变的临床病理学分析

目的 探讨颅内多发病变的临床病理学特征。方法 对2005年1月至2009年12月期间在首都医科大学宣武医院接受治疗病例中,影像学上为颅内多发病变的62例患者的临床、影像以及病理学资料进行回顾性分析。结果 62例中男32例,女30例,平均发病年龄37.4岁,平均病程11.6个月。病灶可累及大脑半球各叶、基底节区、脑干和小脑等部位,以幕上受累较为多见。病理检查结果为：胶质瘤13例,转移瘤13例,中枢神经系统感染12例,免疫介导的炎性脱髓鞘病8例,中枢神经系统原发淋巴瘤5例,血管炎3例,线粒体脑病2例,静脉窦血栓形成2例,Rosai-Dorfman病2例,放射性脑病2例。其中,线粒体脑病、静脉窦血栓形成以皮层受累为主,转移瘤和血源性感染主要累及灰白质交界区,胶质瘤、脱髓鞘疾病和放射性脑病以白质病变为主,血管炎表现为皮层和皮层下白质的病变。结论 多种肿瘤和非肿瘤性疾病在影像学上可以表现为颅内多发病变,其中以胶质瘤、转移瘤和中枢神经系统感染较为多见。积极开展颅内多发病变脑组织活检,临床、影像与病理学密切结合,是提高颅内多发病变诊断水平行之有效的方法。     

Smear patterns and spectrum of premalignant and malignant cervical epithelial lesions in postmenopausal Indian women: A hospital-based study

Cervical cancer is one of the leading causes of morbidity and mortality among women but can be prevented through simple cost‐effective measures, such as creating awareness, and regular screening with the Pap smear, both in the premenopausal and postmenopausal age group. This study was carried out to study the cervical smear patterns and type of cervical epithelial lesions in a group of postmenopausal Indian females and the relationship with clinical profile of patients. Pap smears were taken from 320 postmenopausal Indian females and meticulously screened. Lesions were classified according to type of postmenopausal pattern. 120 smears showed varying degrees of premalignant and malignant changes, which were classified using the Bethesda system. The findings were correlated with duration of menopause, parity, and duration of sexual activity and significance was derived. Histopathological correlation was conducted in those cases where biopsies were available. It was found that as the age of the patients increased, the incidence of low‐grade and high‐grade squamous intraepithelial lesions and carcinoma also increased with the relationship being statistically significant. The occurrence of these lesions also showed an association with increasing parity and period of sexual activity. Thus, it can be concluded that it is important to create widespread awareness about the necessity of regular screening, including the postmenopausal period. Conventional cytology or the Pap smear is a cost‐effective and efficient method for screening of patients but requires training and experience to minimize errors. It is suitable for developing regions where costlier techniques are not in routine use. Diagn. Cytopathol. 2012. © 2011 Wiley Periodicals, Inc.     

胸部原始神经外胚层瘤5例临床病理分析

目的 探讨胸部原始神经外胚层瘤(PNET)的临床病理特征、免疫学表型及其鉴别诊断。方法 对5例发生于胸部的PNET进行光镜观察和免疫组化研究。结果 5例PNET中4例为女性,1例男性,年龄12～52岁,平均27．0岁。肿瘤体积较大,平均直径11．4cm,无包膜或包膜不完整。镜下：肿瘤由小圆细胞构成,细胞胞质少,部分区域肿瘤细胞胞质透亮,可见Homer-Wwright菊形团和假菊形团。免疫表型：5例CD99(MIC2)、NSE阳性,4例synaptophysin阳性,3例vimentin阳性,2例S-100蛋白阳性。结论 胸部PNET是较少见的高度恶性软组织肿瘤,其诊断主要依据病理形态学特征及免疫组化标记。     

Intraoperative cytologic diagnosis of granulomas: A retrospective study of 156 cases

To avoid contamination of equipment and reduce risks of infection, intraoperative cytology (IOC) is a useful substitute to conventional frozen section in the diagnosis of infectious diseases. One of the various histomorphologic patterns of infections is the granuloma, which sometimes may be difficult to diagnose cytologically. In an attempt to assess accuracy and pitfalls of IOC in the diagnosis of granuloma, cases diagnosed as granuloma on IOC or on permanent sections (PS) at George Washington University Medical Center were collected for the period of September 1990 to March 1996. Cyto-histologic correlation was performed. During that time, a diagnosis of granuloma in either the IOC or PS was rendered in 156 of 5,901 IOC cases. IOC showed definite granuloma (87), suspicious for granuloma (23), and neither definite nor suspicious for granuloma in 46 cases. The latter group corresponded to neoplasms (5) and benign conditions (41). Eighty-five cases were accurately diagnosed as definite granuloma by both IOC and PS. Fifty-seven cases diagnosed as granuloma by PS corresponded on IOC to suspicious for granuloma (11), benign smear (41), and neoplasms (5). Only two cases were incorrectly diagnosed as granuloma on IOC: a neoplasm and a case of fibrosis. Overall, four cases of neoplasms were interpreted as suspicious for granuloma (3) or definite granuloma (1) on IOC, and five cases of granulomas were misdiagnosed as neoplasms on IOC. Four of these nine case were deferred for a PS diagnosis. IOC is a useful tool in the diagnosis of granulomas with a sensitivity of 60% and specificity of 99% and positive and negative predictive values of 98% and 99%, respectively. Rarely, neoplasms may be misdiagnosed as granulomas and vice versa. Diagn. Cytopathol. 1998;18:62–66. © 1998 Wiley-Liss, Inc.     

人工智能在中枢神经系统疾病影像诊断中的应用进展

人工智能（AI）技术应用于中枢神经系统疾病的诊断、分型以及预后,可显著提高医学影像信息的可信性和有效性,大幅提高神经系统疾病早期诊断的准确率,为医生选择合理的治疗方案提供定量的依据。本研究介绍了AI在中枢神经影像诊断中常用的学习算法、AI在中枢神经疾病影像诊断中的图像分割和特征提取中的应用;综述了AI在术前胶质瘤分级、预测基因突变状况以及胶质瘤术后复发鉴别的应用;并初步介绍了已用于临床工作的一些软件工具。     

cIMPACT‐NOW update 6: new entity and diagnostic principle recommendations of the cIMPACT‐Utrecht meeting on future CNS tumor classification and grading

cIMPACT‐NOW (the Consortium to Inform Molecular and Practical Approaches to CNS Tumor Taxonomy) was established to evaluate and make practical recommendations on recent advances in the field of CNS tumor classification, particularly in light of the rapid progress in molecular insights into these neoplasms. For Round 2 of its deliberations, cIMPACT‐NOW Working Committee 3 was reconstituted and convened in Utrecht, The Netherlands, for a meeting designed to review putative new CNS tumor types in advance of any future World Health Organization meeting on CNS tumor classification. In preparatory activities for the meeting and at the actual meeting, a list of possible entities was assembled and each type and subtype debated. Working Committee 3 recommended that a substantial number of newly recognized types and subtypes should be considered for inclusion in future CNS tumor classifications. In addition, the group endorsed a number of principles—relating to classification categories, approaches to classification, nomenclature, and grading—that the group hopes will also inform the future classification of CNS neoplasms.     

Intraoperative diagnosis of tanycytic ependymoma: pitfalls and differential diagnosis

Smear preparations have become increasingly popular in the intraoperative assessment of central nervous system pathology. The cytological features of a histologically proven tanycytic ependymoma are presented with the pitfalls and differential diagnosis. The smear preparation showed a glial neoplasm composed of cells with long, bipolar glial processes and oval to spindle-shaped nuclei resembling those seen in pilocytic astrocytoma smears. The smear characteristics of an ependymoma usually show remarkably uniform round-to-oval nuclei, fluffy glial processes, and a perivascular nuclear-free zone (pseudorosetting). None of these features were present in our case. The accompanying frozen section showed a fascicular spindle-cell tumor that resembled a schwanomma, a commonly reported misinterpretation of the histology of tanycytic ependymomas on frozen sections. Careful attention to the radiological findings, the surgeon's impression, and the intraoperative smear preparation details should allow one to include this uncommon entity in the differential diagnosis of spinal neoplasms.     

儿童中枢神经系统肿瘤330例分析

目的 探讨儿童中枢神经系统(CNS)肿瘤的病理特征.方法 按照2007年WHO CNS肿瘤分类标准,对山东大学齐鲁医院1995～2007年间16岁及其以下儿童颅内和椎管内肿瘤进行同顾性分析.结果 儿童CNS肿瘤共330例,占同期全部4 788例CNS肿瘤的6.89%.其中男性196例,女性134例.病理组织学类型前3位依次是:星形细胞瘤94例(28.48%),胚胎性肿瘤58例(17.58%)和颅咽管瘤49例(14.85%).299例颅内肿瘤中,幕上192例,幕下107例.椎管内31例.结论 星形细胞瘤、胚胎性肿瘤和颅咽管瘤是最常见的儿童CNS肿瘤组织学类型.男性好发.随着年龄增长,CNS肿瘤有逐步上升的趋势.前卜位CNS肿瘤中除胚胎性肿瘤和生殖细胞肿瘤外,均以低级别肿瘤多见.     

Prevalence of human parechoviruses in central nervous system infections in children: A retrospective study in Shanghai,China

Human parechoviruses (HPeV) are associated with central nervous system (CNS) infections and sepsis‐like illnesses. However, data from China are not available. The aim of this study was to determine the prevalence, age, and seasonal distributions and genotypes of HPeV infections in children with CNS related disease in Shanghai, China. Of 776 cerebrospinal fluid (CSF) samples collected from children with CNS‐related diseases under the age of 16 years during the years 2008–2011, 68 (9%) were identified to be HPeV positive. The annual prevalence varied remarkably: 1% (2/153) in 2008, 7% (12/177) in 2009, 15% (23/153) in 2010, and 11% (31/293) in 2011. The virus was detected in all age groups of children ranging from 2 days to 13 years and the median age was 14 months. Of the 31 positive samples that were genotyped successfully, 28 were HPeV1 and 3 were HPeV3. This study provided data on the molecular epidemiology of HPeV infections in CNS‐related diseases in Shanghai, China and suggest that the screening for HPeV by PCR should be included in the routine viral testing of CSF. J. Med. Virol. 85:320–326, 2013. © 2012 Wiley Periodicals, Inc.     

5 109例中枢神经系统肿瘤WHO新分类统计分析

目的 探讨新的WHO分类在中枢神经系统肿瘤病理诊断及统计学分析中的意义。方法 对1999年7月～2002年6月3年间华山医院诊治的5109例中枢神经系统肿瘤采用免疫细胞化学ABC法及20余种抗体标记，依据WHO神经系统肿瘤新分类作病理诊断，并作统计分析。结果 在5109例肿瘤中，按WHO(2000)分类，属神经系统肿瘤有3981例，其中神经上皮组织肿瘤l498例(占37．64％)，颅脊神经肿瘤536例(占13．46％)，脑膜肿瘤1379例(占34．64％)，其中脑膜上皮组织肿瘤1130例(占28．38％)和脑膜间叶组织肿瘤249例(占6．25％)。未定组织来源肿瘤(血管母细胞瘤)110例(占2．76％)。淋巴瘤和造血组织肿瘤72例(占1．80％)，胚生殖细胞肿瘤52例(占1．32％)，鞍区颅咽管瘤139例(占3．49％)和转移性肿瘤195例(占4．90％)。同期的非神经系统肿瘤，即垂体腺肿瘤1042例(占20．39％)和其他类肿瘤86例(占1．68％)。结论 脑膜肿瘤和神经上皮组织肿瘤中少突胶质细胞肿瘤比例均有升高，认识先进仪器和设备并应用于肿瘤诊断，并认识少突胶质肿瘤病理形态学本质及胶质母细胞瘤新概念，以及坚持WHO分类的原则是重要的。     

子宫腺瘤样瘤49例临床病理分析

目的探讨子宫腺瘤样瘤的组织发生、临床病理特点及鉴别诊断。方法分析49例子宫腺瘤样瘤临床病理学资料，其中14例行特殊染色和免疫组化染色。结果49例子宫腺瘤样瘤占同期子宫标本的1．3％，肿瘤多位于子宫肌壁间，其次为近子宫角和宫体或宫底浆膜下，内膜下少见。肿瘤直径0．5～5cm，临床表现无特征性。瘤细胞组成形态不一的腺样及腔隙样结构，腔隙内衬以扁平或立方上皮细胞，大多数表现为脉管样形态。全部病例均伴平滑肌增生。14例腔隙内黏液物Alician B1ue染色阳性，PAS染色阴性。免疫表型：不同类型CK、vimentin、SMA及calretinin阳性，FⅧRAg、CEA、EMA、ER及PR阴性。结论子宫腺瘤样瘤并非罕见，临床和病理上均易误诊和漏诊。瘤细胞表达CK和calretinin，不表达FⅧRAg、CEA和EMA，上述指标对子宫腺瘤样瘤的诊断和鉴别诊断均具有重要意义。本组研究结果也支持子宫腺瘤样瘤为间皮来源。     

Two-centre study comparing DNA preparation and PCR amplification protocols for herpes simplex virus detection in cerebrospinal fluids of patients with suspected herpes simplex encephalitis

In a two-centre study, the routine DNA preparation and PCR amplification protocols were compared for herpes simplex virus (HSV) detection in cerebrospinal fluids (CSFs) of 43 patients with suspected herpes simplex encephalitis (HSE). The combined clinical, radiological and laboratory results indicated HSE in 6/43 (14%) patients. Discrepant PCR results between the two centres were obtained in 8 (18%) cases consisting of 5 false-positive and 3 false-negative results. Seven out of 8 (88%) discrepant results were associated with the method of CSF preparation using protease K digestion followed by heat inactivation. In contrast, CSF digestion with proteinase K followed by DNA purification on silica spin columns was better yielding discrepant PCR results in only 1 of 78 analyses (1.3%). The results point to the need for standardization and inter-laboratory quality control for routine clinical work. J. Med. Virol. 57:31–35, 1999. © 1999 Wiley-Liss, Inc.