CT、MRI检查对儿童毛细胞型星形细胞瘤的诊断价值

目的 探讨CT、MRI检查对儿童毛细胞型星形细胞瘤（PA）的诊断价值。方法 选取107例疑似PA患儿,均接受CT、MRI检查,以病理检查结果为金标准,评估CT、MRI检查对PA的诊断价值。结果 病理检查结果显示,107例患者中阳性85例,阴性22例。CT检查诊断PA的灵敏度、特异度、准确度分别为67.06%、40.91%、61.68%,与病理检查结果的一致性一般（Kappa=0.541,P﹤0.01）;MRI检查诊断PA的灵敏度、特异度、准确度分别为78.82%、77.27%、78.50%,与病理检查结果的一致性一般（Kappa=0.608,P﹤0.01）。CT检查诊断PA的特异度和准确度均低于MRI检查,差异均有统计学意义（P﹤0.05）。结论 MRI检查诊断PA的价值较高,诊断特异度和准确度均高于CT检查。     

毛细胞型星形细胞瘤的MRI诊断与病理分析

目的:回顾性分析颅内毛细胞型星形细胞瘤（pilocytic astrocytoma,PA）的MRI表现,并与病理结果对照研究,以提高该病的影像学诊断。方法:分析本院2014年至2017年经病理证实的10例该病患者的临床及影像学资料。结果:10例毛细胞星型细胞瘤中,5例呈囊实性改变,4例呈实性改变,1例呈囊性伴壁结节改变且结节明显强化。术后病理显示,镜下可见疏松区与致密区双极性分布,且比例各不相同,部分可见血管增生及嗜酸性小体。结论:毛细胞型星形细胞瘤在影像学上有一定的特征性,肿瘤多为囊性壁结节型或实性肿块,不同类型的肿瘤镜下显示疏松区与致密区比例不同,强化程度与其毛细血管通透性密切有关,熟悉影像学表现及鉴别诊断,并与相关病理联系,可为临床手术方案的制订提供重要的参考价值。     

16例小脑毛细胞型星形细胞瘤MRI及病理分析

目的 探讨小脑毛细胞型星形细胞瘤的磁共振成像(MRI)影像特点和病理学特征.方法 回顾性分析16例小脑毛细胞型星形细胞瘤的术后病理、术前MRI资料.结果 16例小脑毛细胞型星形细胞瘤中,发生于小脑蚓部11例,小脑半球5例.小脑毛细胞型星形细胞瘤可呈单纯囊肿型、囊肿附壁结节型或瘤囊型.MRI平扫肿瘤境界清楚,无明显瘤周水肿;增强扫描囊壁瘤结节或瘤体部分明显强化,囊壁光滑、强化或不明显强化.显微镜下瘤组织内致密、疏松区双相交替,瘤细胞呈细长梭形,致密区见数量不等Rosenthal纤维,疏松区有微囊样结构、嗜酸性小体形成;肿瘤免疫组化GFAP强阳性.结论 小脑毛细胞型星形细胞瘤MRI影像表现和病理组织学具有特征性,把握其病理特点有助于术前影像诊断.     

血管畸形合并毛细胞星形细胞瘤1例报告

1病例报告患者女性,11岁,因反复头晕、头痛1个月入院。CT示:右侧颞枕叶可见高密度影,范围约3.5 cm×2.5 cm,边界清晰,CT值45～57 HU,周边呈低密度影,周围脑室受压变窄,局灶脑沟消失,中线结构向左侧移位。临床诊断:右侧颞枕叶血管畸形。遂行右侧颞枕叶病灶切除术,术中见:右侧颞枕叶一灰红色结     

31例小脑毛细胞型星形细胞瘤形态学观察

小脑毛细胞型星形细胞瘤是少见的肿瘤，国内文献报告极少。主要表现：头痛、恶心、呕吐、视物不清、走路不稳等颅内压增高症状。肿瘤多位于小脑蚓部、半球及四脑室，大体有囊性变．     

The Pilomyxoid Astrocytoma and its Relationship to Pilocytic Astrocytoma: Report of a Case and a Critical Review of the Entity

Pilomyxoid astrocytoma (PMA) is a rare glioma that shares histopathological similarities with pilocytic astrocytoma (PA). Yet, typical examples of both can be distinguished on clinical and histological grounds. The reported aggressive behavior of PMA provides a rationale for distinguishing this entity from typical PA. We report a 6(1/2) -year-old girl who had suffered poor weight gain, irritability and progressively worsening abnormal eye movements since approximately 2 months of age. Radiographic studies at 6 months of age (age at initial presentation) revealed a large hypothalamic lesion occupying proximal portions of the optic nerves, chiasm and right posterior optic tract. The first biopsy obtained after two chemotherapy regimens was consistent with a diagnosis of PMA. The patient suffered multiple recurrences, and underwent three subsequent surgical procedures. The last two surgical specimens revealed a tumor with histopathological features of PA. She is alive with residual disease 6 years after initial presentation. While earlier studies focused on the similarities between PA and PMA, considering the latter as the "infantile" form of the former, subsequent work outlined their histological and clinical differences. Some even suggested a different cell type, such as the tanycytic cell as the origin for PMA. This report provides evidence in favor of the earlier argument that there is a close relationship between PA and PMA, and presents a rare "maturation" phenomenon, at least from a morphological perspective. More systematic review of such cases will provide a better answer for the origin of PMA, and its relation to PA.     

71例脑星形细胞肿瘤临床预后因素综合分析

[目的]观察脑星形细胞肿瘤治疗的疗效,并探讨采用综合评分方法判断该肿瘤预后的可行性.[方法]回顾性分析71例脑星形细胞肿瘤的临床资料.采用单因素分析筛选出影响预后的临床因素,随后把这些因素进行编码评分,并且累计每个患者的变量值总分.同时将整组患者的编码评分值均分为三个等级的综合评分值,统计分析三个不同等级分值组的预后差异.[结果]71例患者的5年局控率和生存率分别为34.8%和31.1%.单因素分析提示年龄、放疗前KPS、术前临床分期和术后病理类型对局控率和生存率的影响有显著性统计学意义.经综合评分后统计发现:4～6分(9例)、7～9分(36例)和10～12分(26例)组的5年局控率分别为0,13.68%和72.75%(p=0.0000);而5年生存率分别为0,10.35%和71.34%(p=0.0000).[结论]初步结果表明采用临床预后因素综合评分能较可靠而全面地判断脑星形细胞肿瘤的预后.     

脑星形细胞瘤近瘤周白质区的DTI征象及参数分析

[目的]应用磁共振弥散张量成像（DTI）技术探讨脑星形细胞瘤近瘤周白质区DTI征象,以及不同级别星形细胞瘤近瘤周区（IPR）平均弥散系数（MD）值、各向异性分数（FA）值改变的意义。[方法]48例脑星形细胞瘤术前行DTI扫描,重建FA图,评价FA图像中IPR的信号特点,并测定IPR及对侧正常脑白质区的MD值及FA值,计算相对MD（rMD）和相对FA值（rFA）。[结果]星形细胞瘤IPR白质区的FA图及彩色FA图能显示出白质纤维各向异性降低和走形方向的改变。星形细胞瘤IPR白质区MD值高于对侧正常脑白质组（t=11.423,P〈0.001）;除Ⅱ级与Ⅲ级星形细胞瘤组间MD值和rMD无统计学差异外,其余级别星形细胞瘤组间MD值和rMD均有统计学差异（P〈0.05）。星形细胞瘤IPR白质FA值低于对侧正常脑白质组（t=-22.611,P〈0.001）;Ⅲ~Ⅳ级星形细胞瘤IPR白质的FA值、rFA降低,明显低于Ⅰ~Ⅱ级星形细胞瘤组（P〈0.05）。[结论 ]FA图及彩色FA图能较为直观准确地反映IPR白质受肿瘤侵犯的情况;MD值、FA值能够一定程度定量反映不同级别星形细胞瘤对IPR造成的病理影响。     

Observation of Intensity-Modulated Radiotherapy with Different Fractionated Doses Used in 58 Cases with Astrocytoma

OBJECTIVE To analyze the therapeutic effects and side effects of intensity-modulated radiotherapy (IMRT) with different fractionated doses in treating astrocytoma. METHODS During a period from October 2001 to December 2006, 58 patients with astrocytoma were treated using IMRT. Based on the World Health Organization (WHO) classification, 32 of the 58 cases were grade-II, 20 grade-III and 6 grade-IV (glioblastoma multiforme, GBM). Thirty-two of the 58 patients (3 with grade IV, 11 with grade III, and the other 18 with grade II who were over 40 years) were treated with hyperfractionated IMRT (Hyper Fr IMRT), and the other 26 patients were treated with standard fractionated IMRT (St Fr IMRT).RESULTS The 1-, 3- and 5-year overall survival (OS) rates were respectively 86%, 52%, and 45%, and the 1-, 3- and 5-year progression-free survival (PFS) rates were respectively 77%, 38%, and 25%. Using an analytical hierarchy process it was shown that concerning the patients with grade II astrocytoma classified based on WHO grading, the therapeutic effect was much better in the group of Hyper Fr IMRT than in the St Fr IMRT group. There was no statistical significance of the differences in the OS and PFS rates between the 2 groups (P = 0.049 and P = 0.006). The OS and PFS rates of the patients with grade-III astrocytoma were both higher in the group with Hyper Fr IMRT than in the St Fr IMRT group. However, there was no statistical significance of the differences between the 2 groups. Advanced RTOG grade-III (radiation therapy oncology group, RTOG) neurotoxicity occurred only in 1 of the cases. CONCLUSION Compared with the St Fr IMRT, the Hyper Fr IMRT may help to prolong the survival of patients with astrocytoma.     

脊髓髓内星形细胞瘤的临床特点及治疗策略分析

背景与目的：脊髓髓内星形细胞瘤一直是临床治疗的难点,本文旨在分析脊髓髓内星形细胞瘤的临床特点及治疗策略。方法：回顾性分析北京天坛医院2011年5月至2013年5月收治的31例手术治疗的脊髓髓内星形细胞瘤患者的临床资料,包括影像表现、病理类型、手术技巧、术后疗效等,采用McCormick分级和MRI影像学评估手术疗效。结果：肿瘤全切除3例,近全切除15例,部分切除11例,活检2例;术后近期临床神经功能改善1例,无变化23例,加重7例。术后随访3．24个月。20例I～Ⅱ级星形细胞瘤患者中,改善5例,无变化12例,恶化3例;11例高级别星形细胞瘤患者中,好转1例,加重4例,无变化者3例．死亡3例。结论：有明确边界的低级别星形细胞瘤首选显微手术治疗,尽可能全切除肿瘤：对边界不清的高度恶性胶质瘤可在激光刀等辅助技术下充分减压后行放化疗等相关治疗．但预后不良。分子靶向治疗可能是今后解决此问题的关键。     

儿童Xp11.2易位/TFE3基因融合相关性肾癌的影像学表现

目的 探讨儿童Xp11.2易位/TFE3基因融合相关性肾癌(Xp11.2 tRCC)的影像学表现.方法 回顾性分析我院2015年1月-2020年12月经手术病理证实为Xp11.2 tRCC的5例患儿临床及影像学资料,其中4例行CT平扫及增强检查,1例行MRI平扫、增强及DWI检查.观察分析肿瘤的部位、大小、形态、边界、...     

增强磁共振直方图分析鉴别儿童髓母细胞瘤和星形细胞瘤的价值

摘 要：［目的］ 探讨增强MRI直方图分析鉴别儿童髓母细胞瘤和星形细胞瘤的价值。［方法］ 回顾性分析经手术病理证实的47例儿童后颅窝肿瘤,其中髓母细胞瘤29例,星形细胞瘤18例。选取两组肿瘤MR增强矢状位图像最大层面,并用Mazda软件勾画感兴趣区并进行直方图分析,对两组肿瘤直方图参数特征进行分析。［结果］ 利用直方图提取出的9个参数特征中,99百分数差异有统计学意义（P=0.029）,并绘制C99 ROC曲线,ROC曲线下最大面积为0.85,髓母细胞瘤鉴别星形细胞瘤的最佳C99值是176.5,特异性76%,敏感性61%。［结论］增强MRI直方图分析可用于鉴别儿童髓母细胞瘤和星形细胞瘤,为鉴别两者提供可靠的客观依据。     

8例卵巢非霍奇金淋巴临床分析

[目的]探讨卵巢非霍奇金淋巴瘤（NHL）的临床表现、诊断、治疗及预后。[方法]8例临床资料的回顾性分析。[结果]本组病例占同期卵巢恶性肿瘤0.51%(8/1552)，继发5例，原发3例，按FIGO分期Ⅰ期1例，Ⅱ期1例，Ⅲ期3例，Ⅳ期2例，1例未行手术分期不明，病理类型均属非霍奇金淋巴瘤，B细胞性，裂-无裂细胞、混合细胞、小细胞各2例，大无裂及中心细胞各1例，本组单纯化疗1例，余7例均采用综合治疗，随访结果5例死亡，生存期1-21个月，3例存活，[结论]对于青壮年卵巢肿瘤患者，如肿瘤呈实性、双侧性且伴有CA125增高者，应警惕卵巢淋巴瘤的可能；治疗多采用手术和化疗为主的综合治疗；原发较继发预后好，但原发甚罕见。     

脑节细胞胶质瘤8例临床病理学分析

摘 要：［目的］ 探讨节细胞胶质瘤的临床病理学特点。［方法］ 应用组织病理学及免疫组织化学观察8例脑节细胞胶质瘤的组织学特点,并结合文献探讨其病理形态及诊断、鉴别诊断。［结果］5例伴头痛,3例伴慢性癫痫发作;6例呈实性,2例呈囊实性,1例伴钙化。6例完全切除,2例未完全切除;8例组织学上均表现为肿瘤性胶质细胞和发育不良的节细胞;7例为WHO I级,1例为WHO Ⅲ级。免疫组化胶质成分表达GFAP、S-100,而节细胞表达Syn、NSE和CgA。Ki-67增殖指数较低,5例CD34阳性,3例局灶表达CD34。［结论］ 节细胞胶质瘤为生长缓慢的良性肿瘤,大部分属于WHO I级,常见部位为颞叶。主要根据组织学和免疫组织化学进行诊断,完整切除后可治愈。