脑干与脊髓内肿物的组织病理和超微结构研究

目的：研究脑干与脊髓内肿物的类别、分布和组织病理与超微结构特点。方法：取７２例脑干与脊髓内肿物的活检材料，做半薄和超薄切片，光镜与电镜观察。结果：脑干肿瘤２３例，脊髓内肿瘤１５例，脑干血管畸形１９例，脊髓内血管畸形４例，其中３例伴有肿瘤。脑干肿瘤中星形细胞瘤最多，室管膜瘤很少。脊髓内肿瘤中室管膜瘤最多，星形细胞瘤次之，９例脊髓内肿瘤，包括６例室管膜瘤，两极有空洞形成，洞壁淤血水肿。血管畸形中海绵状血管畸形最多，静脉性和毛细血管扩张型较少，可见毛细血管扩张型向海绵状血管畸形的过渡和复合型。结论：星形细胞瘤在光镜下适于按ＷＨＯ的新分级法分为四级。在电镜下需根据核异型的程度和数量及胞质内细胞器的增减来考虑恶性度。室管膜瘤、神经鞘瘤、黑色素瘤和血管外被细胞瘤在电镜下常有特异的微细结构作为确切的诊断依据。脊髓内肿瘤两极的空洞形成，考虑与肿瘤压迫，循环障碍，水肿液蓄积有关。３例脊髓内海绵状血管畸形有肿瘤与空洞并存，其发生可能与肿瘤长期压迫、循环障碍、毛细血管持续扩张有关。

A histopathological and ultrastructural study on masses in the brainstem and the spinal cord

Objective:To study the kinds, distributions and histopathological and ultrastructural features of masses in the brainstem and the spinal cord. Methods: The biopsy materials were taken from 72 cases of masses in the brainstem and the spinal cord. Semithin and ultrathin sections were observed by light and electron microscopy. Results: There were 23 cases with brainstem tumor, 15 cases with spinal cord tumor, 19 cases with vascular malformation in the brainstem and 4 cases with vascular malformation in the spinal cord. Tumor was seen in 3 of 4 cases with vascular malformation in the spinal cord. In the brainstem, astrocytoma was the most common tumor and ependymoma was rare. In the spinal cord, the most common tumor was ependymoma, the second was astrocytoma. Syringomyelia were found in 9 cases with spinal cord tumor. There were congestion and edema in syrinx walls. The cavernous malformation more frequently occured in our cases. Venous malformation and telangiectasis coulfd be seen in a few cases. The transitional appearance from telangiectasis to cavernous malformation and the comlex types could be seen. Conclusions: Our study indicated that the astrocytoma may be devided into 4 grades according to WHO new classification under light microscope. Under electron microscope, it is necessary to consider the amount and degree of nuclear atypia and the amount of protoplasmic organelles simultaneously. Usually, there were some microstructural features in ependymoma, neurilemoma, melanoma and haemangiopericytoma which can be used for diagnosis exactly. The syrinx located by the ends of spinal cord tumor might be resulted from tumor pressure, circulatory disturbances and edematous fluid accumulation. 3 cases of cavernous malformation in spinal cord were coexisted with tumor and syrinx, it might be related to the persistent circulatory disturbances and capillary dilatation resulted from the prolonged tumor compression.