目的：探讨脑多形性黄色瘤型星形细胞瘤（pleomorphic xanthoastrocytoma，PXA）的病理特征。方法：对1例左侧海马脑 PXA 进行头颅 MRI 检查、病理检查及免疫组织化学检查，并对其结果进行分析。结果：头颅 MRI 在左侧海马发现直径约0．8mm 的斑片状异常信号影，T1W1稍低信号，T2W1稍高信号，部分囊影呈现高信号，边界不清楚，未见明显占位效应。其余脑组织的信号均匀，异常信号影未见。光镜检查结果显示肿瘤组织含较多砂粒体、似黄色瘤样，与正常脑实质的界限欠清，细胞形态多样，由梭形、单核样及椭圆形等形态细胞组成，多核瘤巨细胞也散在可见，瘤细胞胞浆有的含脂滴，瘤细胞间质可见嗜酸性颗粒小体，灶区附近可见散在淋巴粒细胞浸润。对 PXA 患者进行免疫组织化学及组织化学特染发现，肿瘤细胞表达中 GFAP、CD34、S －100、Vimenin 为阳性，EMA、CD163、NF、NeuN 染色为阴性，Ki －67增殖指数小于2％；对其进行网状纤维染色，可发现网状纤维网将瘤细胞分割包绕于其中。结论：脑 PXA 的临床影像学及病理特征具有一定的特征性，正确认识其特征对其临床诊断和治疗具有指导作用。%Objective:To investigate pathological characteristics in patients with pleomorphic xanthoastrocytoma. Methods:One paitent with pleomorphic xanthoastrocytoma in left hippocampus was reopted.She was diagmosed by cranial MRI,pathology and immunohistochemistry.Results:There was diameter 0.8mm patchy abnormal signal in left hippocampus by MRI inspection,T1W1 lower signal,T2W1 slightly higher signal,part of the capsule showed high sig-nal shadow boundary was not clear,no significant mass effect.Signals of the remaining brain tissue was uniform,no abnormal signal.Light microscopic examination showed that the tumor tissue contained more sand body,like yellow tumor samples with normal brain parenchyma less clear boundaries,morphological diversity,the spindle -shaped,sin-gle -core samples and oval shape of cells,multinucleated giant cell tumor also scattered in the visible,some cytoplasm of tumor cells containing lipid droplets,between tumor cell stroma eosinophilic granular bodies.Near the kitchen area scattered lymphoid granulocyte infiltration.Immunohistochemical staining and special staining:In tumor cells ex-pressed GFAP,CD34,S -100,Vimenin positive,EMA,CD163,NF,NeuN staining was negative,Ki -67 proliferation index of less than 2%,its reticular fibers dyed fiber mesh networks can be found in the surrounding tumor cells.Con-clusion:The clinical and pathological features of brain imaging PXA has certain characteristics,correct understanding of its characteristics is useful in clinical diagnosis and treatment.
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