间变性少突神经胶质瘤

Bang

54岁女性，平衡失调伴头痛2-3周，并逐渐加重。

Axial NECT (A). Image shows a large densely calcified mass in the right middle cranial fossa with mass effect and leftward midline shift.

横断位CT平扫示右侧中颅凹肿块，内可见多发钙化，占位效应明显，中线结构向左侧移位。

Axial T2WI (B), FLAIR with Tractography (C), precontrast T1WI (D) and postcontrast T1WI (E). Images show an intra-axial heterogeneous mass in the right temporal lobe and insula that is predominantly hyperintense on T2WI and hypointense on T1WI with faint scattered central enhancement. The mass has very little associated parenchymal edema and displaces the corticospinal tracts (red) and the inferior longitudinal fasciculus (green).

横断位T2WI、FLAIR伴纤维束成像、T1WI平扫及增强后T1WI图像示：右侧颞叶、岛叶不均质肿块，T2WI以高信号为主，T1WI呈低信号；增强后，病灶内部可见散在无强化区。肿块周围无明显水肿，皮质纤维束（红色）、大脑下纵束（绿色）受压移位。

Anaplastic Oligodendroglioma

间变性少突神经胶质瘤

背景

WHO grade III glial tumor – Increased mitotic activity differentiates this case from WHO grade II oligodendroglioma.

此例病例的有丝分裂活性增加，不同于WHO II级的少突神经胶质瘤，而应属于WHO III级的神经胶质类肿瘤

Oligodendroglial neoplasms represent 5–18% of gliomas. Twenty to 54% of oligodendrogliomas are anaplastic.

少突神经胶质瘤约占全部胶质瘤的5-18%，其中20%-54%为间变性。

临床表现

Typically seen in men in the 6th to 7th decade of life

好发于60-70岁男性

Seizure is the most common presenting symptom.

最常见的临床症状：癫痫

影像诊断要点

Frontal and temporal lobe predominant intra-axial primary glial neoplasms

额叶、颞叶原发性神经胶质肿瘤，一般位于脑内。

Poor contrast enhancement

增强扫描强化不明显。

May have cystic degeneration, hemorrhage, calcification

可见囊变、出血、钙化。

Up to 90% demonstrate calcifications

约90%的瘤内可见钙化。

鉴别诊断

Astrocytoma: Most common intra-axial mass and can have calcifications

星形细胞瘤：最常见的脑内肿瘤，可见钙化

Meningioma Most common extra-axial mass and often densely calcified

脑膜瘤：最常见的脑外肿瘤，常可见钙化。

Supratentorial ependymoma: 40–80% have calcifications

幕上室管膜瘤：约40-80%可见钙化

Glioblastoma

胶质母细胞瘤

PNET (in younger patients)

原始神经外胚层肿瘤（多见于儿童）

治疗要点

Surgery plus-or-minus chemotherapy (surgery alone in young patients)

手术切除±化疗（年轻患者可不采取化疗）