毛细胞型星形细胞瘤的临床特征及显微手术治疗

Clinical characteristics and microscopic surgery of pilocytic astrocytoma

目的探讨毛细胞型星形细胞瘤(PA)及其亚型毛细胞黏液样型星形细胞瘤(PMA)的临床特征、显微手术治疗及其预后。方法回顾性分析经手术和病理证实的29例PA(包括2例PMA)的临床资料。结果 27例PA显微镜下见瘤细胞多呈梭形,细胞核为圆或椭圆型,细胞质染色呈淡红色,细胞内一端或两端有毛发丝状的胶质纤维;部分区域细胞排列紧密,肿瘤细胞呈平行波浪状或交错状编织排列,间质内血管丰富;可见典型Rosenthal纤维,网状纤维染色阴性;免疫组化染色示胶质纤维酸性蛋白(GFAP)为(+)^(++),波形蛋白(Vim)为(+)^(++);2例PMA显微镜下可见黏液样基质内富含突起呈网状的瘤细胞,呈散在或绕血管周围分布;瘤组织内未见明显Rosenthal纤维和嗜酸性颗粒小体形成;免疫组化染色示GFAP(+)。行肿瘤全切除术17例,术后未予放化疗等辅助治疗,未见肿瘤复发,预后良好;行肿瘤大部切除术10例,术后予以放疗,1例复发;行MRI导向下立体定向活检术2例,术后予以放疗,肿瘤体积明显缩小。结论 PA患者行显微外科手术全切除预后良好,对于未全切除患者术后辅以放疗亦能取得理想效果。

Objective To review the clinical characteristics and microscopic surgery pilocytic astrocytoma （PA） and pilomyxoid astrocytoma （PMA）. Methods Clinical data of 29 pathologically-confirmed PA patients, including 2 case MPA were reviewed retrospectively. Results Most of PA cells under microscope were spindle-shaped with round or elliptic nuclei and the cytoplasm stained reddish, one or two ends of cells had hairy glial fibers. Some cells were closely packed, tumor cells were arranged as parallel wavy or cross weaving with rich vessels in the interstitial tissue. Typical Rosenthal fibers were present, and the staining of reticular fibers was negative. Immunohistochemical staining of glial fibers in acidic protein （GFAP） was （＋） - （＋ ＋）, vimentin （Vim） was （＋） - （＋ ＋）. In 2 PMA cases, protuberant net-like tumor cells were observed among the myxoid matrix, which were diffusely distributed or surrounding blood vessels. No distinct Rosenthal fiber and eosinophilic granular corpuscle forming were observed in the tumor tissue, Immunohistochemical staining showed GFAP （＋）. Seventeen patients underwent total resection without post-operative radiation or chemotherapy or other adjuvant therapy. There was no tumor recurrence and the prognosis was satisfactory. Ten patients underwent surgical subtotal resection, followed by postoperative radiotherapy. There was 1 case of recurrence. Two patients underwent MRI guided stereotactic biopsy, then received postoperative radiotherapy and the tumor size significantly decreased. Conclusion Favorable prognosis can be achieved for patients with pilocytic astrocytoma after microscopic total resection, subtotal resection combined with postoperative radiation is also effective.