室管膜下瘤:一例报告并文献复习

Subependymoma:a case report and the review of literatures

目的报告1例室管膜下瘤患者的临床和病理学特征,并复习相关文献。方法与结果男性患者,54岁。突发意识障碍,全身抽搐,短暂失忆。MRI检查显示左侧侧脑室内占位性病变,增强扫描部分区域明显强化,脑室扩张、积水。手术中可见肿瘤组织呈灰白色,边界清楚,血运中等,质地柔软,分块切除。光学显微镜观察,肿瘤细胞成团、成簇分布于致密胶质纤维基质中,并可见许多微囊腔结构形成,微囊腔中有少许嗜酸性蛋白蓄积物;肿瘤细胞大小均匀一致,无明显异型性;胞核呈圆形或卵圆形,未见核分裂象。免疫组织化学染色,肿瘤细胞胶质纤维酸性蛋白和巢蛋白表达阳性,但不表达神经元核抗原,Ki-67抗原标记指数<1%。结论室管膜下瘤是发生于脑室系统、生长缓慢的少见良性肿瘤,以成年男性高发,手术完全切除肿瘤预后良好。

Objective To report a rare case of subependymoma and explore its clinical and pathological features. Methods The clinical presentations, histopathological and immunohistochemical features of a case of subependymoma were studied retrospectively. The related literatures were also reviewed. Results A 54-year-old male patient presented with sudden loss of awareness, generalized convulsion and transient loss of memory. Magnetic resonance imaging （MRI） showed a space-occupying lesion located in the left ventricle. The lesion was focally enhanced. Lateral ventricle was enlarged with hydrocephalus. During operation, tumor tissue was soft, grayish in colour and well circumscribed. The blood supply was moderate. The tumor nodule was resected, measuring 3 em x 2 cm x 2 em. Microscopically, tumor cells distributed in conglobation or group in dense fibrillary matrix of glia and many microcysts could be seen. Some eosinophilic protein fluid were accumulated in the mierocysts. Tumor cells were similar in size without any atypia. Tumor cell nuclei were round or elliptical and no karyokinesis was Immuohistochemistry showed glial fibrillary acidic protein （GFAP） and nestin were positively expressed in tumor cells. The Ki-67 labeling index was less than 1%. Neuronal nuclear antigen （NeuN） was negatively expressed. The patient was followed up for 6 months and no recurrence was found. Conclusion Subependymoma is one of the rare benign tumors of the central nervous system. High incidence appears in male adults. Its long-term prognosis is good after surgical complete resection.