多形性黄色星形细胞瘤的临床及影像学特征分析
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摘要
目的探讨多形性黄色星形细胞瘤的临床及影像学特征。方法对2012年1月至2016年6月在广东三九脑科医院癫痫外科,接受手术治疗的10例多形性黄色星形细胞瘤患者的临床及影像学资料进行回顾性分析。结果 MRI检查示,10例患者均为囊实性改变,其中3例患者为大结节小囊、7例患者为小结节大囊;病变位于左颞叶7例、左颞枕交界区1例、右颞叶1例及左侧额中央区1例;增强扫描示,7例患者的肿瘤实性部分和壁结节明显强化,1例患者软脑膜强化,2例患者无强化。8例患者行肿瘤全切术,2例患者行部分切除术。10例患者的临床疗效均满意,术后9例癫痫患者均无发作,1例患者的头痛缓解。随访时间为1～5年不等,术后复查均无复发征像。结论多形黄色星形细胞瘤临床表现多以癫痫发作起病;影像学检查常见囊结节改变,病变多位于幕上,占位及水肿效应轻。最终诊断需依赖病理学检查。
Objective To explore the clinical and neuroimaging features of pleomorphic xanthoastrocytoma( PXA). Methods The clinical and image data of 10 patients with PXA underwent operation in Guangdong 999 Brain Hospital from 2012 to 2016 were analyzed retrospectively. Results 10 cases were cystic solid type( 3 cases of large nodular follicles,7 cases of small nodules,large cysts),located in different lobes( 7 in left temporal lobe,1 in left temporal occipital junction,1 in right temporal lobe and 1 in left frontal lobe). The solid part or wall nodule of tumors showed obviously enhancement with sharp edge in 7 cases. 1 cases showed leptomeningeal enhancement,no enhancement effect in 2 cases. 8 cases underwent total resection and 2 underwent subtotal resection. 7 cases were seizures free,2 cases improved significantly,and 1 case had headache relief. The follow-up from 1 to 5 years showed there was no recurrence after the operation. Conclusions The majority of patients with pleomorphic astrocytoma have epilepsy. The neuroimaging features are usually characterized by cystic nodules,especially large cystic small nodules,accompanyed by enhancement of cystic nodules. Mostly located in the supratentorial,the occupying effect and edema were mild. The morbidity is low,and sometimes it is difficult to identify other low-grade cystic tumors associated with epilepsy. The final diagnosis depends on pathology.
Objective To explore the clinical and neuroimaging features of pleomorphic xanthoastrocytoma( PXA). Methods The clinical and image data of 10 patients with PXA underwent operation in Guangdong 999 Brain Hospital from 2012 to 2016 were analyzed retrospectively. Results 10 cases were cystic solid type( 3 cases of large nodular follicles,7 cases of small nodules,large cysts),located in different lobes( 7 in left temporal lobe,1 in left temporal occipital junction,1 in right temporal lobe and 1 in left frontal lobe). The solid part or wall nodule of tumors showed obviously enhancement with sharp edge in 7 cases. 1 cases showed leptomeningeal enhancement,no enhancement effect in 2 cases. 8 cases underwent total resection and 2 underwent subtotal resection. 7 cases were seizures free,2 cases improved significantly,and 1 case had headache relief. The follow-up from 1 to 5 years showed there was no recurrence after the operation. Conclusions The majority of patients with pleomorphic astrocytoma have epilepsy. The neuroimaging features are usually characterized by cystic nodules,especially large cystic small nodules,accompanyed by enhancement of cystic nodules. Mostly located in the supratentorial,the occupying effect and edema were mild. The morbidity is low,and sometimes it is difficult to identify other low-grade cystic tumors associated with epilepsy. The final diagnosis depends on pathology.
引文
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[2]汪文胜,宋亭,成丽娜,等.脑神经节神经胶质瘤的CT和MRI表现[J].临床放射学杂志,2011,30:120.
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[15]张宗军,贾传海,朱宗明,等.颅内毛细胞型星形细胞瘤的影像学表现与临床病理对照研究[J].临床放射学杂志,2009,28:1445.
[16]楚建军,姜旭红,祁佩红,等.毛细胞型星形细胞瘤的MRI表现及病理基础[J].中国CT和MRI杂志,2014,12:19.
[17]Parmar HA,Hawkins C,Ozelame R,et al.Fluid-attenuated inversion recovery ring sign as a marker of dysembryoplastic neuroepithelial tumors[J].J Comput Assist Tomogr,2015,31:348.
[18]Fernandez C,Girard N,Paz Paredes A,et al.The usefulness of MRimaging in the diagnosis of dysembryoplastic neuroepithelial tumor in children:a study of 14 cases[J].AJNR,2003,24:829.
[19]吴小伟,陈自谦.胚胎发育不良性神经上皮瘤一例[J].功能与分子医学影像学杂志:电子版,2014,3:47.
[20]胡春洪,汪文胜,方向明主编.MRI诊断手册[M].第2版.北京:人民军医出版社,2013:101.
[21]黄亮,杨振峰,翟昭华,等.胶质母细胞瘤的常规MRI诊断[J].川北医学院学报,2012,27:117.
[22]孟悛非,梁碧玲.临床MRI诊断学[M].广州:广东科技出版社,2005:37.
[23]陈星荣,沈天真.血管母细胞瘤[J].中国医学计算机成像杂志,2003,9:208.
[2]汪文胜,宋亭,成丽娜,等.脑神经节神经胶质瘤的CT和MRI表现[J].临床放射学杂志,2011,30:120.
[3]Louis DN,Ohgaki H,Wiestler OD,et al.The 2007 WHOclassification of tumours of the central nervous system[J].Acta Neuropathologica,2007,114:97.
[4]米良,杨海贵,李海龙,等.多形性黄色星形细胞瘤11例报道并文献复习[J].延安大学学报:医学科学版,2017,15:39.
[5]Musara A,Kalangu KK,Dzowa MN,et al.Parieto-temporal pleomorphic xanthoastrocytoma in a black African child[J].Asian J Neurosurg,2017,12:298.
[6]Rao AA,Laack NN,Giannini C,et al.Pleomorphic xanthoastrocytoma in children and adolescents[J].Pediatr Blood Cancer,2010,55:290.
[7]Gil-Gouveia R,Cristino N,Farias JP,et al.Pleomorphic xanthoastrocytoma of the cerebellum:illustrated review[J].Acta Neurochir(Wien),2004,146:1241.
[8]Whittle IR,Gordon A,Misra BK,et al.Pleomorphic xanthoastrocytoma.Report of four cases[J].J Neurosurg,1989,70:463.
[9]Allegranza A,Ferraresi S,Bruzzone M,et al.Cerebromeningeal pleomorphic xanthoastrocytoma.Report on four cases:clinical,radiologic and pathological features.(Including a case with malignant evolution)[J].Neurosurg Rev,1991,14:43.
[10]Gon9alves VT,Reis F,Queiroz Lde S,et al.Pleomorphic xanthoastrocytoma:magnetic resonance imaging findings in a series of cases with histopathological confirmation[J].Arq Neuropsiquiatr,2013,71:35.
[11]Moore W,Mathis D,Gargan L,et al.Pleomorphic xanthoastrocytoma of childhood:MR imaging and diffusion MRimaging features[J].AJNR,2014,35:2192.
[12]赵有财,李南云,周晓军.毛细胞型星形细胞瘤的临床和病理学研究进展[J].中华病理学杂志,2007,36:846.
[13]Koeller KK,Rushing EJ.From the archives of the AFIP:pilocytic astrocytoma:radiologic-pathologic correlation[J].Radiographics,2004,24:1693.
[14]Malik A,Deb P,Sharma MC,et al.Neuropathological spectrum of pilocytic astrocytoma:an Indian series of 120 cases[J].Pathol Oncol Res,2006,12:164.
[15]张宗军,贾传海,朱宗明,等.颅内毛细胞型星形细胞瘤的影像学表现与临床病理对照研究[J].临床放射学杂志,2009,28:1445.
[16]楚建军,姜旭红,祁佩红,等.毛细胞型星形细胞瘤的MRI表现及病理基础[J].中国CT和MRI杂志,2014,12:19.
[17]Parmar HA,Hawkins C,Ozelame R,et al.Fluid-attenuated inversion recovery ring sign as a marker of dysembryoplastic neuroepithelial tumors[J].J Comput Assist Tomogr,2015,31:348.
[18]Fernandez C,Girard N,Paz Paredes A,et al.The usefulness of MRimaging in the diagnosis of dysembryoplastic neuroepithelial tumor in children:a study of 14 cases[J].AJNR,2003,24:829.
[19]吴小伟,陈自谦.胚胎发育不良性神经上皮瘤一例[J].功能与分子医学影像学杂志:电子版,2014,3:47.
[20]胡春洪,汪文胜,方向明主编.MRI诊断手册[M].第2版.北京:人民军医出版社,2013:101.
[21]黄亮,杨振峰,翟昭华,等.胶质母细胞瘤的常规MRI诊断[J].川北医学院学报,2012,27:117.
[22]孟悛非,梁碧玲.临床MRI诊断学[M].广州:广东科技出版社,2005:37.
[23]陈星荣,沈天真.血管母细胞瘤[J].中国医学计算机成像杂志,2003,9:208.