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目的探讨脊髓内黑色素性室管膜瘤的疾病特点、诊断及治疗。方法分析北京天坛医院神经外科收治的1例椎管内黑色素性室管膜瘤病例,并复习相关文献。结果核磁MRI影像表现为T1高信号,T2低信号,增强稍见强化。对比放疗前后4个月的磁共振影像,该肿瘤大小无明显变化。组织学检查见肿瘤细胞内含黑色素颗粒,经氧化、脱色后行HE染色见不典型的血管周围假菊形团和室管膜菊形团结构。肿瘤大部切除后患者神经功能障碍加重。随访5个月,神经功能障碍渐恢复,复查MRI肿瘤无增大。结论黑色素性室管膜瘤因瘤内含有丰富的黑色素而在影像显示T1高信号,T2低信号。组织学检查结合肿瘤与室管膜的密切关系可确定诊断。手术是最佳治疗方案,但切除程度应予个体化,不建议术前放疗。
Objective To investigate the characteristics, diagnosis and treatment of melanocytic ependymoma in the spinal cord. Methods One case of meningotrophic meningioma in the spinal canal admitted to Department of Neurosurgery, Beijing Tiantan Hospital was analyzed. The related literatures were reviewed. Results MRI manifestations of T1 high signal, T2 low signal, enhanced a little to see enhanced. Compared with 4 months before and after radiotherapy of magnetic resonance imaging, the tumor size no significant change. Histological examination of tumor cells containing melanin particles, after oxidation, bleaching HE staining, see the typical peritubular pseudo-daisy and ependymal chrysotile structure. Patients with neurological dysfunction worsened after tumor resection. After 5 months of follow-up, neurological dysfunction gradually recovered and there was no increase in MRI findings. Conclusion Melanocytic ependymoma shows high signal of T1 and low signal of T2 in the image because of rich melanin in the tumor. Histological examination combined with the close relationship between the tumor and the ependymal membrane can confirm the diagnosis. Surgery is the best treatment, but the degree of resection should be individualized, preoperative radiotherapy is not recommended.