大脑胶质瘤病的分型探讨(附13例报告)

Gliomatosis cerebri：clinical study of 13 cases and comparison of mass forming and diffuse types

摘要:

目的 探讨大脑胶质瘤病（gliomatosis cerebri，GC）的分型及影像和病理学特征。方法 对本院神经外科2010年3月至2012年11月间收治的13例GC进行分型对比研究。结果 GC的临床表现以头痛（8/13）和癫痫（3/13）常见。影像学检查显示弥漫性病灶累及大脑半球3个或3个以上脑叶及中枢结构，MRI呈长T1、长T2异常信号，增强扫描通常无强化，MRS也具有诊断价值。光镜和电镜结果显示肿瘤组织多以星形胶质细胞瘤多见（9例），也可为少突胶质细胞瘤（2例）。依据组织学表现，GC 1型以低级别星形胶质细胞瘤多见。结论 可将GC分为两型，并且各具有不同的影像和病理学特征，1型GC以星形细胞瘤常见，临床上可依据分型的不同选择个体化的治疗方法。

Abstract:

Objective To evaluate the clinicopathologic and neuroimaging findings of GC and to compare the clinical findings between Type 1 and Type 2 GC.Methods Clinical comparison between subtypes and clinical analysis were performed.Results The clinical manifestions of these 13 patients included headache (8/13) and seizure (3/13).Radiological examination revealed diffuse lesions infiltative process involving more than three cerebral lobes,a diagnosis of MRS should be considered. Histologically, 13 cases of GC were classified into low and high grade histologic grades by cytologic anaplasia. Low-grade GC was more common in Type 1 than Type 2.Immunohistochemical and Ultramicrostructure Results demonstrated that the infiltrating tumor cells were undifferentiated cells with astrocytic or oligodendroglial differentiation.Conclusions Type 1 and 2 GC are somewhat different in neuroimaging and pathologic features. Type 1 GC were undifferentiated cells with astrocytic common. Treatment of GC was based on magnetic resonance imaging findings and histological confirmation for patients.