Anaplastic astrocytomas with abundant Rosenthal fibers in elderly patients: a diagnostic pitfall of high-grade gliomas
Anaplastic astrocytomas with abundant Rosenthal fibers in elderly patients: a diagnostic pitfall of high-grade gliomas
复制标题
老年患者中具有丰富罗森塔尔纤维的间变性星形细胞瘤：高级别胶质瘤的诊断陷阱
DOI：
10.1111/neup.12025
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发表时间：
2013
期刊：
影响因子：
2.3
通讯作者：
Morioka M
中科院分区：
文献类型：
--
作者：
Sugita Y;Nakashima S;Ohshima K;Terasaki M;Morioka M
为探讨间变性星形细胞瘤（AA）的临床病理特征，对4例年龄≥70岁的AA患者进行了分析。在组织学上，这些肿瘤由弥漫性浸润性星形细胞瘤组成，具有明亮的嗜酸性胞浆颗粒或软木塞或珠状束。肿瘤细胞呈多形性，奇异的巨细胞，有丝分裂活动，但没有坏死。PAS染色细胞质颗粒呈阴性。免疫组化显示胶质纤维酸性蛋白（GFAP）阳性反应。胞浆嗜酸性颗粒或束呈αB-晶状体蛋白、遍在蛋白和HSP 27阳性。此外，在所有病例中，肿瘤细胞均显示异柠檬酸脱氢酶1（IDH 1）-R132 H蛋白的强胞质阳性。这些病例的MIB-1标记指数范围为7%至10%。在病例1和2中，超微结构上，肿瘤细胞在细胞质和突起中具有电子致密的无定形结构。这些结构与神经胶质中间丝结合。根据这些显微镜、免疫组化和超微结构的表现，病例1被诊断为AA，伴有大量、混合型、普通型RF和微小（m）RF;病例2、3和4被诊断为AA，伴有大量mRF。这些结果表明，星形细胞肿瘤中RF的存在并不一定排除高级别星形细胞瘤的诊断。此外，老年患者中具有丰富mRF的AA应归类为AA的特殊变体。
To investigate the clinicopathological features of anaplastic astrocytoma (AA) with abundant Rosenthal fibers (RFs), this study assessed four cases of AA (elderly patients; age ≥70 years). Histologically, these tumors were composed of diffusely infiltrating astrocytomas with brightly eosinophilic cytoplasmic granules or cork‐screw or beaded bundles. Tumor cells showed pleomorphism, bizarre giant cells, and mitotic activity, but no necrosis. The cytoplasmic granules showed negativity on PAS staining. Immunohistochemically, the tumor cells with cytoplasmic granular cells showed a positive reaction for GFAP. The cytoplasmic eosinophilic granules or bundles were positive for αB‐crystallin, ubiquitin and HSP27. In addition, tumor cells showed strong cytoplasmic positivity for isocitrate dehydrogenase 1 (IDH1)‐R132H protein in all cases. The MIB‐l labeling index of these cases ranged from 7% to 10%. In cases 1 and 2, ultrastructurally, the tumor cells had electron‐dense, amorphous structures in the cytoplasm and in the processes. These structures were bound to glial intermediate filaments. Based on these microscopic, immunohistochemical and ultrastructural findings, case 1 was diagnosed as AA with abundant, mixed, common type of RFs and miniature (m) RFs, and cases 2,3, and 4 were diagnosed as AA with abundant mRFs. These results indicate that the presence of RFs in astrocytic tumors does not necessarily exclude a diagnosis of high‐grade astrocytoma. In addition, AAs with abundant mRFs in elderly patients should be classified as a peculiar variant of AA.