Cerebellar astrocytomas. Part II. Pathologic features indicative of malignancy.
Cerebellar astrocytomas. Part II. Pathologic features indicative of malignancy.
复制标题
小脑星形细胞瘤。
作者：
Ilgren Eb;C. Stiller
本文描述了1938年至1984年间在牛津雷德克里夫医院观察到的112例小脑星形细胞瘤的病理特征，这些病理特征表明临床预后不佳。这些已经与文献中许多其他报告的发现进行了审查。结论如下：多形性：相当比例的小脑星形细胞瘤表现出明显的核和细胞质大小变化。这在十岁以后尤为常见。此外，明显的多形性肿瘤与非常短的生存时间有关。有丝分裂象：8.5%的小脑星形细胞瘤可见有丝分裂象，但大量发现的病例仅占1.1%。它们在成人和完全实体瘤中更常见。小脑星形细胞瘤中任何有丝分裂象的存在都与存活至死亡的显著降低以及复发率的显著增加有关。细胞结构：13.2%的小脑星形细胞瘤可见明显的局灶性细胞增多，在儿童肿瘤中尤为常见。如果有标记，则与死亡生存时间的显著缩短有关。结缔组织增生：在一半的小脑星形细胞瘤中可见肿瘤附近的结缔组织增生反应，但仅在16%的病例中可见。然而，当被标记时，它们与总生存时间的减少有关。血管周围假性星形细胞瘤：在80.9%的小脑星形细胞瘤中可见。当大量发现时，它们在儿童中比在囊性和实性混合肿瘤中更常见。当发现与微囊变和内皮增生相关时，它们的出现与良好的预后相关，但当单独发现时，它们与较差的生存率相关。坏死：16.8%的病例发现小的坏死灶。明显坏死肿瘤是非常罕见的，更常见于患者短的历史和预后很差。明确的恶性特征：1。多形性，如果有标记；2. 有丝分裂的图形，任何数目；3. 细胞状，如果有标记；4. 有明显的结缔组织增生（可能）；5. 血管周围假性小血管，孤立无微囊性改变和内皮细胞增生；6. 坏死，如有标记。原发性恶性小脑星形细胞瘤：这种肿瘤是罕见的，代表小脑星形细胞瘤的一个或多个区域包含上述恶性特征。原发性小脑胶质母细胞瘤：这些肿瘤也很罕见，在临床和病理上与神经系统其他部位的胶质母细胞瘤相似。（摘要删节为400字）
The pathologic features which denote poor clinical outcome in a series of 112 cerebellar astrocytomas seen at The Radcliffe Infirmary, Oxford between 1938 and 1984 have been described. These have been reviewed in relation to the findings of numerous other reports in the literature. The conclusions reached are as follows: Pleomorphism: A substantial proportion of cerebellar astrocytomas display significant nuclear and cytoplasmic size variation. This is particularly common after the age of ten. Markedly pleomorphic tumors are, moreover, associated with a very short survival time. Mitotic Figures: Mitotic figures are seen in 8.5% of cerebellar astrocytomas but are found in large numbers, in only 1.1% of cases. They are more common in adults and in totally solid tumors. The presence of any mitotic figures in cerebellar astrocytomas is associated with a marked reduction in survival to death and also a noticeable increase in the rate of recurrence. Cellularity: Marked focal hypercellularity is seen in 13.2% of cerebellar astrocytomas and is especially common in childhood tumors. When marked, it is associated with a significant reduction in survival time to death. Desmoplasia: Desmoplastic reactions adjacent to tumor are seen in one-half of all cerebellar astrocytomas but are only marked in 16% of cases. When marked, however, they are associated with a reduction in overall survival time. Perivascular Pseudorosettes: These are seen in 80.9% of all cerebellar astrocytomas. When found in large numbers, they are more commonly seen in children than in tumors with a mixed cystic and solid form. Their appearance is associated with a favorable outcome when found in association with microcystic change and endothelial hyperplasia but when found in isolation they are associated with poor survival. Necrosis: Small necrotic foci are found in 16.8% of cases. Markedly necrotic tumors are very rare and are more commonly seen in patients with short histories and associated with very poor outcome. Definite malignant features: 1. Pleomorphism, if marked; 2. Mitotic figures, in any number; 3. Cellularity, if marked; 4. Desmoplasia (probably) if marked; 5. Perivascular pseudorosettes, in isolation without microcystic change and endothelial hyperplasia; 6. Necrosis, if marked. Primary malignant cerebellar astrocytomas: These tumors are rare and represent cerebellar astrocytomas with one or more areas containing the aforementioned malignant features. Primary glioblastomas of the cerebellum: These tumors are also rare and resemble both clinically and pathologically glioblastomas found in other parts of the nervous system.(ABSTRACT TRUNCATED AT 400 WORDS)