Parwani Anil V, Taylor David C, Burger Peter C, Erozan Yener S, Olivi Alessandro, Ali Syed Z
Departments of Pathology and Neurosurgery, Johns Hopkins Hospital, 600 North Wolfe Street, Baltimore, Maryland 21287, USA.
Acta Cytol. 2003 May-Jun;47(3):325-31. doi: 10.1159/000326528.
To analyze the differential diagnosis when keratinized squamous cells are found in a brain aspirate.
Twenty cases of brain aspirates with keratinized squamous cells were retrieved (1982-2001). Diagnoses included craniopharyngioma (CP) (n = 11), metastatic squamous cell carcinoma (SCC) (n = 5), epidermoid cyst (EC) (n = 3) and Rathke cleft cyst (RCC) (n = 1). Aspirates were obtained under stereotactic radiologic (CT) guidance. Smears were stained with Diff-Quik or Papanicolaou stain, and cell block sections were stained with hematoxylin and eosin. Radiologic and histopathologic correlation with subsequent resection specimens was performed in selected cases.
CP showed cellular smears with numerous keratinized squamous cells in a background of degenerated cellular and keratinaceous debris. Also noted were clusters of anucleate squamous cells, multinucleated giant cells, histiocytes, calcified debris and characteristic fragments of basaloid epithelial cells. Metastatic SCC showed single cells and tissue fragments of markedly atypical and focally keratinized cells with enlarged, hyperchromatic nuclei; prominent pleomorphism in a background of necrotic cellular debris and acute inflammatory exudate. EC showed numerous isolated keratinized squamous cells often with prominent keratohyaline granules and occasional parakeratotic cells in a relatively clean background. RCC showed single cells and aggregates of benign-appearing squamous cells admixed with numerous anucleate squames and hemosiderin-laden macrophages. Glandular-type epithelium was present only rarely.
Squamous cell-containing lesions in the brain present a spectrum of pathologic entities. Although they all display the common morphologic denominator of keratinizing squamous cells, subtle cytomorphologic differences exist in these lesions, permitting an accurate cytopathologic diagnosis. Clinicardiologic features and anatomic location of the tumor in the brain are additionally helpful.
分析脑穿刺物中发现角化鳞状细胞时的鉴别诊断。
检索了20例含有角化鳞状细胞的脑穿刺物病例（1982 - 2001年）。诊断包括颅咽管瘤（CP）（n = 11）、转移性鳞状细胞癌（SCC）（n = 5）、表皮样囊肿（EC）（n = 3）和拉克氏囊肿（RCC）（n = 1）。穿刺物在立体定向放射学（CT）引导下获取。涂片用Diff - Quik或巴氏染色，细胞块切片用苏木精和伊红染色。在部分病例中对放射学和组织病理学与后续切除标本进行了相关性分析。
颅咽管瘤显示细胞涂片，在退化的细胞和角质碎片背景中有大量角化鳞状细胞。还可见无核鳞状细胞簇、多核巨细胞、组织细胞、钙化碎片以及基底样上皮细胞的特征性碎片。转移性鳞状细胞癌显示单个细胞和组织碎片，细胞明显异型，局部角化，核增大、深染；在坏死细胞碎片和急性炎症渗出物背景中可见明显的多形性。表皮样囊肿显示大量孤立的角化鳞状细胞，常伴有明显的透明角质颗粒，在相对干净的背景中偶尔可见不全角化细胞。拉克氏囊肿显示单个细胞和外观良性的鳞状细胞聚集体，混有大量无核鳞状上皮细胞和含铁血黄素的巨噬细胞。仅偶尔可见腺型上皮。
脑内含有鳞状细胞的病变呈现一系列病理实体。尽管它们都表现出角化鳞状细胞这一共同的形态学特征，但这些病变在细胞形态学上存在细微差异，有助于进行准确的细胞病理学诊断。肿瘤在脑内的临床和放射学特征以及解剖位置也有辅助诊断价值。
