原发性椎管内畸胎瘤6例临床病理分析

Spinal cord teratoma:a clinicopathologic study of 6 cases

目的探讨原发性椎管内畸胎瘤的临床病理特点。方法收集手术切除的原发性椎管内畸胎瘤6例,复习其临床资料,光下观察组织形态,并结合文献讨论。结果 6例患者男女各3例,年龄24～47岁,平均年龄31岁;肿瘤部位腰段4例,颈段1例,骶尾部1例,均位于髓外硬脊膜下。5例囊性成熟性畸胎瘤,镜下可见成熟的鳞状上皮、消化道及呼吸道柱状上皮、纤维平滑肌组织、脂肪组织等;1例囊性畸胎瘤,局部癌变为腺癌,镜下除可见成熟囊性畸胎瘤成分外,局灶柱状上皮细胞有癌变,癌细胞明显异型性,呈腺样或实性条索状排列,侵犯囊壁。结论原发性椎管内畸胎瘤少见,主要发生于中青年,多位于胸、腰段椎管髓外硬膜下;病理类型多为囊性成熟性畸胎瘤,极少数可以癌变。

Objective To study the clinicopathologic features of spinal cord teratoma.Methods The clinical and pathologyical data were reviewed in 6 cases of spinal teratoma.Specimens were processed with fixing,embedding and HE staining,and then examined microscopically.Results There were 3 males and 3 females with an average age of 31 years（range from 24-47 years）.The lesions were located at the level of lumbar spine for 4 cases,1 case had lesion at cervical spine,and another case at sacrococcygeal spine.6 tumors were located in the subdural-extramedullary and intramedullary regions.5 cases were mature cystic teratoma and showed the mature components of squamous epithelium,digestive tract epithelium,respiratory columnar epithelium,smooth muscle fibers and fat tissue by light microscopy.1 case was teratoma with malignant transformation and showed malignant changes of adenocacinomatous type,such as focal prominant columnar epithelial atypia and adenoid or solid cord-like arrangement of cancerous tissue infiltrating the surrounding stroma,in addition to other benign and mature components of mature cystic teratoma.Conclusion Spinal teratomas are very rare,mainly occurring in young and middle aged people.The tumors are mainly located at the level of thoracic-lumbar spine.Mature cystic teratoma is the major pathological type.Very few spinal teratomas has malignant transformation.