124例中枢神经系统病变冰冻切片误(未)诊分析

Analysis of the pathological misdiagnosed or undiagnosed CNS lesions by frozen section in 124 cases

目的通过124例神经系统占位性病变的冰冻切片误(未)诊病例总结,分析误(未)诊病例的病理特点,归纳以脑肿瘤为主的中枢神经系统病变冰冻切片误(未)诊的原因并探讨诊断及鉴别要点。方法回顾性分析我院经手术治疗的3000例中枢神经系统病变冰冻切片资料并与手术后石蜡切片对应分析,对证实为误(未)诊的124例进行综合分析。结果误(未)诊病例中神经上皮组织肿瘤42例(星形细胞瘤20例,少突胶质细胞瘤4例,节细胞胶质瘤和中枢神经细胞瘤各5例,脉络丛瘤和髓母细胞瘤各2例,室管膜瘤、副节瘤、松果体细胞瘤、原始神经外胚层瘤各1例),外周神经肿瘤3例,脑膜肿瘤10例,间叶及组织来源不明肿瘤22例,淋巴瘤及造血性肿瘤13例,生殖细胞肿瘤3例,鞍区肿瘤及其他17例,转移癌8例,炎症性改变6例。误(未)诊原因分为:未诊11例(8.87%),制片不良12例(9.68%),取材不当22例(17.74%),读片错误36例(29.03%),其他43例(34.68%)。结论正确的冰冻切片诊断需要获取全面的临床资料和足够的病变组织;病理医师要有充实的病理基础和较全面的临床和影像学知识。病理医师与手术医师的密切配合是保证冰冻切片诊断准确无误的重要环节。

Objective To analyze the pathological characteristics and summarize the causes of misdiag-nosed(undiagnosed)cases of space occupying CNS lesion(mainly the cerebral tumor)and study the key point of diagnosis and differential diagnosis through reviewing the124cases of neurological lesion misdiagnosed or undiagnosed by pathological frozen sections.Methods The data of frozen sections in3000patients with CNS lesions were retrospectively analyzed by comparing with postoperative paraffin sections,a total of124patients were confirmed as misdiagnosed(or undiagnosed)cases,then the clinical and histopathological patterns of these patients were comprehensively analyzed.Results Of the124cases,42were derived from neuroepithe-lial tissue(20astrocytomas,4oligodendrogliomas,5ganglioglioma and5central neurocytoma,2choroids plexus tumor and2medulloblastoma,1ependymoma,1paraganglioma,1pineal parenchymal tumor and1primary neuroectodermal tumor);3peripheral nerve tumors;10meningiomas,22from mesenchymal and un-certain origin;13lymphomas and haemopoietic neoplasms,3germ cell tumors;17were from sellar region and unclassified;8metastasis and6infectious lesions.The misdiagnosed and undiagnosed causes included:undi-agnosed11cases(8.87%);poor quality sections12cases(2梗叮福ィ籭nadequate specimen22cases(17.74%);misdiagnosis36cases(29.03%)and other43cases(34.68%).Conclusion Sufficient clinical data and ade-quate specimen are very important for the correct pathological findings in frozen section.A pathologist should have abundant knowledge in pathology,clinical medicine and radiological imaging,especially the close cooperation between pathologists and surgeons is the key link in assuring the correct diagnosis with frozen section.