中枢系统神经母细胞瘤的影像表现及其病理分析(附4例报告)

CT,MRI Featuresand Pathological Findings of CNS Neuroblastomas

目的探讨中枢系统神经母细胞瘤的影像学表现。方法回顾性分析经病理证实的4例神经母细胞瘤的CT、MRI表现,并结合文献及病理分析。结果儿童2例,平均年龄3.5岁;成人2例,平均年龄34.5岁。肿瘤分别位于额叶(1例),脑室内(1例),颅内硬膜下(1例)及髓外硬膜内(1例)。肿瘤体积较大,均伴坏死、囊变或出血。肿瘤实性部分CT像上呈等或稍高密度,MR T1WI上呈等或稍低信号,T2WI上呈稍高信号,坏死、囊变呈低密度或长T1、T2信号;增强扫描均明显强化。肿瘤组织镜下瘤细胞体积小,大小较一致,胞浆少,细胞核圆形、卵圆形或不规则形,染色深,可见核分裂,部分瘤细胞局部形成小菊形团样结构;瘤细胞团之间可见小血管明显增生,其中3例免疫组织化学均示神经元特异性烯醇化酶(NSE)、突触素(Syn)、神经微丝蛋白(NF)表达(+)。结论中枢神经母细胞瘤好发于儿童,其CT、MRI表现有一定的特征性,最终诊断有赖于病理和免疫组织化学。

Objective To explore the CT and MR characteristics of CNS neuroblastoms and to find the correlation be- tween imaging features and pathology findings. Methods CT and MR imaging features and pathological findings of 4 pa- tients with CNS neuroblastomas confirmed by pathology were analyzed retrospectively. Results The 4 patients included 2 children （average age of 3.5 years old） and 2 aduhs （average age of 34.5 years old）. The tumors located in the frontal lobe in 1, parietal lobe in 1, Intracranial subdural in 1,, extramedullary intradural in 1.. The tumors showed big size with cystic necrosis and haemorrhage. The solid component of all tumors showed high density on CT images and iso or hypointen- sity on T1 weighted MR images and iso or slightly hyperintensity on T2 weighted images. The solid component of the tumors strikingly enhanced. CNS neuroblastomas were composed with sheets of small, undifferentiated cells with hyperchromatic nuclei, scanty cytoplasm. Atypical Homer Wright rosettes and significant hyperplastic small blood vessel were usually pres- ented. 3 of the tumors expressed NSE,Syn and NF. Conclusion Primary Cerebral Neuroblastomas often occured in chil- dren. The CT, MR imagings have some characteristics, but the final diagnosis relies on pathological and immunohistochemi- cal examinations.