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目的探讨多形性黄色瘤型星形细胞瘤(PXA)的临床病理学特点及CD34在其鉴别诊断中的应用价值。方法对3例多形性黄色瘤型星形细胞瘤的临床特点、影像学表现、组织学形态及免疫组化结果进行观察,并结合文献复习讨论。结果 3例患者平均年龄23岁,2例位于顶叶,1例位于额叶。影像学上3例均位于幕上,其中1例呈囊性,囊内壁小结节明显强化;2例以结节状实性病变为主,未见强化。组织学均可见黄瘤样细胞和血管周围淋巴细胞浸润,其中2例伴梭形细胞成分,3例均未见核分裂象和血管内皮细胞增生。免疫组化示黄瘤样细胞CD68和GFAP(+),CD34弥漫(+),Syn散在(+),Ki-67增殖指数为2%～4%。结论 PXA是一种罕见的具有特殊影像学和临床病理特点的星形细胞肿瘤。CD34是PXA的一种敏感标记物,对于诊断PXA及与其他脑肿瘤相鉴别具有较高的应用价值。
Objective To investigate the clinicopathological features of pleomorphic xanthooblastoma (PXA) and the clinical value of CD34 in the differential diagnosis of it. Methods The clinical features, imaging findings, histological features and immunohistochemical results of 3 pleomorphic pleomorphic astrocytomas were observed and reviewed. Results The average age of 3 patients was 23 years old, two in the parietal lobe and one in the frontal lobe. Three cases of imaging were located on the screen, one case was cystic, cystic wall nodules significantly enhanced; 2 cases of nodular solid lesions, no enhancement. Histology showed that both xanthoma cells and perivascular lymphocytes infiltration, including 2 cases with spindle-shaped cell components, no cases of mitosis and vascular endothelial cell hyperplasia in 3 cases. Immunohistochemistry showed that xenograft cells were CD68 and GFAP (+), CD34 diffuse (+), Syn scattered (+), Ki-67 proliferation index was 2% to 4%. Conclusion PXA is a rare astrocytoma with special features of imaging and clinicopathology. CD34 is a sensitive marker of PXA, which is of high value in diagnosing PXA and differentiating it from other brain tumors.