多形性黄色瘤型星形细胞瘤13例报道并文献复习

Pleomorphic Xanthoastrocytoma: A Report of 13 Cases and Literature Review

目的探讨多形性黄色瘤型星形细胞瘤的影像学表现及其治疗及预后,并分析影像学特征对预后的影响。方法回顾性分析武汉协和医院13例经手术病理证实的脑多形性黄色瘤型星形细胞瘤临床特点及MRI平扫及增强表现,其中1例进行了脑DWI检查,1例1 H-MRS检查,并探究其MR表现及其对预后的影响。结果 12例位于大脑半球浅表部位,其中肿瘤位于颞叶6例,额叶4例,顶、枕叶2例;1例病灶位于桥小脑角区。囊腔结节型9例,其中7例为大囊小结节,2例大囊大结节;实质型3例,囊型1例。增强扫描肿瘤结节及实质型瘤体均明显强化,瘤周不同程度水肿。所有患者均行肿瘤切除术,全切10例,大部分切除术3例。术后放疗4例,放化疗3例。术后随访平均2.7年,恢复满意10例,其中癫痫消失8例,头疼缓解2例;复发2例,死亡1例。结论多形性黄色瘤型星形细胞瘤多表现为良性,少数病例可能有恶变可能。MR对多形性黄色瘤型星形细胞瘤的诊断以及与邻近结构关系的确定有指导作用,还能指导放疗,制定手术方案并预测预后,术后应对有残余、复发或间变病例及时进行放、化疗。

Objective To examine the imaging manifestations and treatment of pleomorphic xanthoastrocytoma,and their effects on prognosis. Methods Clinical characteristics and non-enhanced and enhanced MR images of 13 cases of pleomorphic xanthoastrocytoma were retrospectively analyzed,and the relevant literatures were reviewed. Results Among the 13 cases,the tumor occurred in temporal lobe in 6,in frontal lobe in 4,in parietal lobe and occipital lobe in 2 and in cerebellopontine angle in 1. Nine patients presented with nodules on cyst wall,including cystic lesion with small mural nodule （n= 7） or large mural nod- ule （n=2）. Three cases were classified into solid type and 1 into cyst type. Enhanced MR imaging showed that tumor nodules were obviously strengthened,with different degrees of edema in the adjacent areas. Conclusion Pleomorphic xanthoastrocytomas are, in general,of benign nature and, very rarely, undergo transformation to malignant tumors. MR imaging can help to diag nose pleomorphic xanthoastrocytoma,understand the structures adjacent to the tumors, formulate the surgical and radiothera peutic strategies and predict the prognosis.