THE SIGNIFICANCE OF ATYPIA AND HISTOLOGIC MALIGNANCY IN PILOCYTIC ASTROCYTOMA OF THE CEREBELLUM - A CLINICOPATHOLOGICAL AND FLOW CYTOMETRIC STUDY
THE SIGNIFICANCE OF ATYPIA AND HISTOLOGIC MALIGNANCY IN PILOCYTIC ASTROCYTOMA OF THE CEREBELLUM - A CLINICOPATHOLOGICAL AND FLOW CYTOMETRIC STUDY
复制标题
DOI：
10.1177/088307389400900317
复制
发表时间：
1994-07-01
影响因子：
1.9
通讯作者：
JACK, CR
中科院分区：
文献类型：
--
作者：
TOMLINSON, FH;SCHEITHAUER, BW;JACK, CR
生物恶性毛细胞星形细胞瘤是罕见的。精确的形态学标准使其能够与更普通的毛细胞星形细胞瘤进行鉴别和临床上有意义的区分。用于纤维星形细胞瘤的组织学分级方案——基于核非典型性、细胞增生、有丝分裂活性、内皮细胞增殖和坏死——被认为与毛细胞星形细胞瘤的预后无关。尽管如此，我们在107例小脑毛细胞星形细胞瘤中系统地寻找了这些特征，其中4例在组织学上是恶性的。对这些病例的临床、形态学和流式细胞术特征进行了研究。在典型的毛细胞星形细胞瘤中，自发发生组织学恶性肿瘤的发生率为0.9%；辐射后发生的是1.8%。4例组织学恶性肿瘤发生于2男2女，年龄6 ~ 18岁。所有人都显示有丝分裂活性增加（每高倍显微镜视野[250倍]有3到活的有丝分裂）。内皮细胞增生和坏死各3例和2例。DNA倍体分析显示自发发生的恶性肿瘤为非整倍体，而先前放射的肿瘤均为四倍体；5% ~ 11%的细胞处于S期。毛细胞性星形细胞瘤的组织学恶性肿瘤的出现是罕见的，与预后的相关性也不如原纤维性星形细胞瘤。这类肿瘤的基本特征包括高有丝分裂指数和可能高百分比的细胞处于S期。
Biologically malignant pilocytic astrocytomas are rare. Precise morphologic criteria permitting their identification and clinically meaningful distinction from more ordinary pilocytic astrocytomas have not been developed. The histologic grading schemes applied to fibrillary astrocytomas-ones based on nuclear atypia, increased cellularity, mitotic activity, endothelial proliferation, and necrosis-are thought not to correlate with prognosis in pilocytic astrocytomas. Nonetheless, these features were systematically sought in 107 cerebellar pilocytic astrocytomas, four of which were histologically malignant. The clinical, morphologic, and flow cytometric features of these cases were studied. The incidence of histologic malignancy occurring spontaneously in otherwise typical pilocytic astrocytomas was 0.9%; that occurring after radiation was 1.8%. The four histologically malignant tumors occurred in two males and two females, ages 6 to 18 years. All showed increased mitotic activity (three to live mitoses per high-power microscopic field [250x]). Endothelial proliferation and necrosis were present in three and two cases each. DNA ploidy analysis showed the spontaneously occurring malignant-appearing tumors to be aneuploid, whereas both previously radiated tumors were tetraploid; 5% to 11% of cells were in S phase. The appearance of histologic malignancy in pilocytic astrocytoma is rare and less reliably correlated with prognosis than in patients with fibrillary astrocytomas. Essential features of such tumors include a high mitotic index and perhaps a high percentage of cells in S phase.