儿童颅内未成熟畸胎瘤(附30例报告)

目的 探讨儿童颅内未成熟畸胎瘤的临床特征、治疗策略和预后.方法 回顾性分析30例经手术及病理证实的未成熟畸胎瘤患儿的临床资料,26例获得随访.结果 19例术前行血和(或)脑脊液肿瘤标记物(AFP,B-HCG)检测,12例阳性.初次手术肿瘤全切15例,近全切7例,大部切除6例,部分切除2例.随访患儿中,23例行辅助治疗.患儿半年、1年及2年的生存率分别为80%、69%、60%,患儿的存活时间与肿瘤的切除程度筹异有统计学意义(P<0.05).结论 肿瘤标记物的检测有助于诊断.手术是首选的治疗措施,应尽量做到全切.术后应辅以放、化疗.     

235例颅内转移性肿瘤的临床病理与预后

目的：探讨免疫组织化学方法在寻找颅内转移性肿瘤原发病灶中的作用。方法;采用常规病理学方法和／或免疫组织化学技术对２３５例颅内转移性肿瘤进行了检测,并对其中能定期随访的１４５例患者进行了回顾性分析。结果：２３５例颅内转移性肿瘤绝大多数来源于肺癌,部分来源于甲状腺癌,胃肠道癌,乳腺癌和绒毛膜上皮癌等。通过免疫组化方法均能较及时正确的诊断。结论：免疫组织化学方法对寻找颅内转移性肿瘤的原发病灶具有重要价值     

颅内脑膜黑色素细胞瘤的临床与病理

目的:探讨颅内脑膜黑色素细胞瘤的临床与病理特征。方法:分析4例病人的临床表现、影像学检查、病理学特性、治疗方法及预后等资料。结果:光镜检查可见瘤细胞内有大量黑色素颗粒。免疫组织化学检查S-100蛋白、抗黑色素瘤抗体呈强阳性,而细胞角蛋白、上皮膜抗原、胶质纤维酸性蛋白呈阴性。术后随访1～5年半未见肿瘤复发。结论:脑膜黑色素细胞瘤是起源于软脑膜黑色素细胞的一类良性肿瘤,颅内任何部位均可发生。手术全切肿瘤并辅以放疗是治疗的最佳选择。     

脑星形细胞瘤的临床病理与预后

脑星形细胞瘤的临床病理与预后吴秀枝黎辉王则胜陈家禄杨平高泽年我们在了解脑星形细胞瘤８４０例临床情况的同时，进一步分析各种形态学对预后的影响，如肿瘤部位、组织学分级、血管增生、术后放疗和（或）化疗、中草药治疗等因素，对临床判断预后均有重要作用。资料和方...     

颅内脑膜瘤的临床病理分析

本文报道颅内脑膜瘤1999例,男性占44.6％、女性占55.4％,平均年龄43±13岁,主要发生在大脑凸面、矢状窦旁、大脑镰旁、蝶骨嵴等部位。后期的1313例脑膜瘤中良性占87.6％、恶性占12.4％,良性脑膜瘤中内皮型占53.8％,纤维型占32.0％,过渡型6.8％、混合型0.8％,分型不详6.6％。天幕上的脑膜瘤以内皮型多见,天幕和后颅窝脑膜瘤以纤维型多见;恶性脑膜瘤中血管母细胞型占73.8％。脑膜肉瘤和良性脑膜瘤恶性变者占26.2％。恶性脑膜瘤好发于矢状窦旁、大脑镰旁、中颅窝和天幕,其发生率男性高于女性。     

原发性中枢神经系统生殖细胞肿瘤临床病理分析17例报告

目的探讨原发性中枢神经系统生殖细胞肿瘤临床病理特点。方法收集17例原发性中枢神经系统生殖细胞肿瘤,分析、总结其临床病理特点。结果17例中枢神经系统生殖细胞肿瘤病人中15例生殖细胞瘤,1例畸胎瘤,1例混合型生殖细胞肿瘤。年龄7～30岁,男性13例,女性4例。发生于松果体4例,鞍区3例,鞍上2例,丘脑2例,第三脑室5例,脊髓髓内1例。常见症状：头痛、恶性、呕吐；复视、视野缺失；多饮、多尿；双下肢无力、行走不稳,麻痹等。其中伴有性早熟4例,生长发育迟缓1例,性功能减退1例,闭经1例。巨检肿瘤多呈灰白色、实质性。镜下肿瘤细胞多角形,胞浆空泡状,细胞核大,核仁明显,核分裂相可见,间质伴有淋巴细胞浸润。17例病人均经手术治疗,术后辅以放疗。12例病人平均随访4．3年,11例存活。结论中枢神经系统生殖细胞肿瘤罕见,组织学上类似于性腺来源生殖细胞肿瘤,几乎全部发生于身体中线部位。主要发生于少年儿童。免疫组化PLAP阳性有助于诊断。该疾病对放疗极其敏感,预后良好。     

分期不同入路切除儿童颅内巨大肿瘤(附50例报告)

目的 探讨治疗儿童颅内深部巨大肿瘤的手术方法.方法 分期不同入路切除儿童颅内深部巨大肿瘤50例.结果 肿瘤全切除50例,无死亡、昏迷等其他后遗症.其中颅咽管瘤40例,星形细胞瘤5例,畸胎瘤2例,未成熟畸胎瘤2例,脑膜瘤1例.随访最长5年,未见肿瘤复发.结论 儿童颅内肿瘤多位于中线,巨大者多见,儿童生理条件脆弱,血容量少,一次全切除肿瘤风险大,而且很难做到彻底全切除.而分期不同入路是切除儿童颅内深部巨大肿瘤较好的方法,可以获得十分满意的治疗效果.     

颅内浆细胞肉芽肿(附五例报告及文献复习)

目的 探讨中枢神经系统浆细胞肉芽肿的诊断及治疗。方法 对我院1997年1月至2002年3月收治的5例颅内浆细胞肉芽肿的临床资料进行回顾性分析。结果 5例病人，2例位于左顶叶，余3例分别位于右颞叶、右额叶和枕骨大孔区，头CT显示为高密度，MRI为长或等T1、长T2信号，注射造影剂后明显增强。术前诊断为脑转移瘤、脑囊虫病、脑脓肿和脑膜瘤，术后经病理和免疫组化染色发现肿物主要由3种成熟的细胞组成，即浆细胞、淋巴细胞和组织细胞，以浆细胞为主，浆细胞胞浆内κ、γ轻链均呈阳性表达。手术切除后给予激素治疗，预后良好。结论 颅内浆细胞肉芽肿少见，易引起误诊，免疫组化检查有助于鉴别诊断，手术切除和激素治疗效果较好。     

中枢神经系统肿瘤的病理

简明地介绍脑肿瘤的病理检查以及诊断原则 ,并根据 2 0 0 0年世界卫生组织 (WHO)关于神经系统肿瘤的分类 ,扼要介绍主要颅脑肿瘤的病理特点 ,着重介绍 1 0种特殊类型的神经上皮肿瘤的临床和病理特点以及治疗上的考虑     

颅内生殖细胞肿瘤的诊断和治疗（附38例临床分析）

目的 临床分析颅内生殖细胞肿瘤。方法 回顾10年间病理证实的38例颅内生殖细胞肿瘤,鞍区12例,基底节8例,三脑室5例,松果体区4例,其他部位包括下丘脑等。结果 手术切除32例,单纯活检6例;术后行放疗26例,其中4例接受化疗。随访18例,其中活检后行放疗4例,均恢复正常生活。结论 颅内生殖细胞肿瘤的首选治疗方法是放疗,采用局部肿瘤照射,手术的目的主要在于明确肿瘤的性质,为放化疗提供依据,除成熟的畸胎瘤外无需做到手术全切。     

Solitary intracranial plasmacytoma

Solitary intracranial plasmacytomas (SIPs) are rare tumours that may be mistaken radiologically for meningiomas. According to the literature, the predominant feature on polytomography and computed tomography (CT) is a bone-eroding, contrast-enhancing soft tissue mass, part of which might have extended extracranially before initial presentation. The lesions can be solitary and are therefore amenable to surgical excision. Although no recurrence is seen for up to 10 years after treatment, some authors believe progression to multiple myeloma is inevitable. Lesions that are extramedullary in origin are thought to have the best prognosis. We describe three cases treated surgically at Westmead Hospital in the past 6 years. All had CT features similar to those reported previously. On magnetic resonance imaging, which in this condition has not been fully documented, the lesions were slightly hyperintense with the brain on T1-weighted sequences, and were inhomogeneous and hyperintense with T2-weighted images. The two patients who received intravenous contrast showed dense and uniform enhancement. Occasional intralesional signal voids suggested increased vascularity, which was confirmed surgically. The presence of intracellular immunoglobulins may account for the hyperintensity on T2 sequence. Although no specific imaging features were identified to distinguish meningiomas from SIP, the latter should be included in the differential diagnosis of solitary bone eroding intracranial tumours.     

Impaired vision associated with a solitary intracranial plasmacytoma

Solitary intracranial plasmacytomas (SICPs) are extremely uncommon tumors in the central nervous system, and are often misdiagnosed pre-operatively. We report a patient with SICP, describe the neuroradiological and neurosurgical features and the clinical management of this patient, and review the pertinent literature.     

Solitary intracranial plasmacytoma: Two patients with extended follow-up

Solitary neoplastic proliferation of plasma cells (plasmacytoma) rarely occurs in the central nervous system. The longest follow-up in nine previously reported patients was 5 years. We have followed two patients with solitary intracranial plasmacytoma for 8 and 13 years, respectively. At the time of biopsy diagnosis, neither showed involvement of the adjacent calvarium or evidence of a systemic plasma cell dyscrasia. The first patient underwent partial excision of a mass in the right occipital lobe that showed no gross or microscopic involvement of the dura. The second patient had partial resection of a mass arising from dura and invading the left temporal lobe. Postoperative irradiation was given to both patients. No clinical or radiological sign of recurrent brain tumor has developed in either patient during the extended follow-up period. Neither patient has had laboratory or clinical evidence of a systemic plasma cell dyscrasia. Solitary intracranial plasmacytoma may be a “curable” brain tumor.     

Solitary intracranial extra-osseous plasmacytoma presenting with ophthalmic signs.

Solitary plasmacytomas rarely develop in the skull, meninges, or brain. Ophthalmic signs as the initial manifestations of solitary intracranial plasmacytoma have rarely been described. We report the neuro-ophthalmologic, imaging, and pathologic findings for two patients. One patient presented with optic neuropathy, the second with bilateral sixth nerve palsies. Plasmacytoma is a treatable intracranial tumor that should be considered in the differential diagnosis of patients who present with optic neuropathy or sixth nerve palsy.     

Solitary plasmacytoma with intracranial intraorbital and, paranasal sinus extension.

Intracranial solitary plasmacytomas (ICSPs) are extremely rare tumours in neurosurgical practice, and are often misdiagnosed preoperatively. Here we present a solitary intracranial plasmacytoma with orbital, nasal and paranasal sinus extension. A subtotal excision of the tumour was performed and the complete response was seen after postoperative radio-chemotherapy. The neuroradiological and neurosurgical features of the case are discussed with the pertinent literature.     

多形性黄色星形细胞瘤临床病理分析

目的探讨多形性黄色星形细胞瘤(PXA)的临床病理学特征、诊断与鉴别诊断、发病机制、治疗及预后。方法对1例PXA进行临床影像学与病理分析及免疫组化研究。结果患者男性,25岁,因反复抽搐8年入院。头颅MRI显示左侧海马斑片状异常信号影,直径约0.9cm。镜下肿瘤细胞呈多形性,包括梭形、单核样细胞及多核瘤巨细胞等,这些细胞被网状纤维包绕在其中,间质可见嗜酸性颗粒小体。有的瘤细胞胞浆内含有脂滴,灶区可见血管周淋巴细胞浸润。但不见坏死、病理性核分裂及血管内皮细胞增生。免疫组化染色肿瘤细胞表达GFAP、Viminten、S-100和CD34,Ki-67增殖指数小于2%,EMA、Neu N、NF和CD163染色为阴性。结论 PXA是一种主要发生于儿童及青少年罕见的致痫性星形细胞瘤,组织学分级为WHO II级。若能手术完整切除,则预后良好。但是原发性具有间变特征的PXA和复发性伴有恶性转化的PXA的预后却是相当差的,因为他们都属于高级别的胶质瘤。     

Sixth nerve palsy as a presenting sign of intracranial plasmacytoma and multiple myeloma.

Multiple myeloma and plasmacytoma are rare causes of mass lesions at the skull base and cavernous sinus. Sixth nerve palsy, in isolation or in combination with other cranial neuropathies, may occur rarely as the initial presenting feature of multiple myeloma. We report the neuro-ophthalmologic, radiologic, and pathologic findings for two patients who developed sixth nerve palsies as an initial manifestation of intracranial plasmacytoma and multiple myeloma. One patient presented with an isolated sixth nerve palsy in the setting of multiple vasculopathic risk factors. Treatable skull base lesions, including plasmacytoma and multiple myeloma, must be considered in patients with sixth nerve palsies, especially among those who demonstrate a progressive course or multiple cranial neuropathies.     

巨细胞性胶质母细胞瘤一例

目的探讨巨细胞胶质母细胞瘤(GCG)的临床病理特征、诊断及鉴别诊断。方法对1例巨细胞胶质母细胞瘤进行临床病理分析及免疫组化研究。结果巨细胞胶质母细胞瘤组织学特征为瘤细胞形态多样,以巨怪形多核巨细胞为主,核分裂像和坏死多见,网状纤维沿血管周围分布。瘤细胞弥漫表达Vim、S-100及GFAP灶性阳性,Ki-67约为20%。结论 GCG是一种罕见的具有特殊临床病理特征的及预后差的中枢神经系统肿瘤。病理组织学上需与多形性黄色瘤型星形细胞瘤、胶质肉瘤等鉴别。