Taraszewska Anna, Czernicki Zbigniew, Andrychowski Jarosław
Department of Experimental and Clinical Neuropathology, Mossakowski Medical Research Centre, Polish Academy of Sciences, Warsaw, Poland.
Folia Neuropathol. 2005;43(3):172-7.
The pilocytic astrocytoma is only rarely associated with gross intratumoral hemorrhage despite rich vasculature and blood vessel changes, accompanied often by perivascular depots of hemosiderin. We report an unusual case of pigmented cerebellar pilocytic astrocytoma presenting with posttraumatic hemorrhage in a 38-year-old man with no history related to the tumor. CT and MRI examination after head injury demonstrated unexpectedly the cystic lesion of 2 cm in diameter in the region of the right cerebellar hemisphere and vermis. The lesion was associated with hematoma and it was surgically removed 3 weeks after trauma. Histopathological examination revealed pilocytic astrocytoma tissue with broad hemorrhagic changes and with an unusual pattern of massive pigmentation of the cytoplasm of pilocytic astrocytes, consistent with hemosiderosis. Positive stains for iron and ferritin and ultrastructural study confirmed deposition of hemosiderin granules in the tumour cells. There was no evidence of melanin or melanosomes. This finding of hemosiderin accumulation in the cytoplasm of neoplastic astroglia seems to be analogous to post-hemorrhagic pigmentation of the normal Bergmann glia and subpial astrocytes. In the literature, the examples of neuroepithelial tumors with hemosiderin pigmentation of tumor cells have been rarely documented. To our knowledge, this is the first reported case of pigmented pilocytic astrocytoma exhibiting extensive intracellular hemosiderin deposition.
尽管血管丰富且血管有改变，常伴有血管周围含铁血黄素沉积，但毛细胞型星形细胞瘤极少与肿瘤内大量出血相关。我们报告一例罕见的色素性小脑毛细胞型星形细胞瘤病例，该病例发生于一名38岁男性，无肿瘤相关病史，表现为创伤后出血。头部受伤后的CT和MRI检查意外发现右侧小脑半球和蚓部区域有一个直径2 cm的囊性病变。该病变伴有血肿，并在创伤后3周进行了手术切除。组织病理学检查显示为毛细胞型星形细胞瘤组织，伴有广泛的出血改变，毛细胞型星形胶质细胞的细胞质有异常的大量色素沉着模式，符合含铁血黄素沉着症。铁和铁蛋白染色阳性以及超微结构研究证实肿瘤细胞内有含铁血黄素颗粒沉积。没有黑色素或黑素小体的证据。肿瘤性星形胶质细胞胞质内出现含铁血黄素积聚这一发现似乎与正常伯格曼胶质细胞和软膜下星形胶质细胞出血后的色素沉着类似。在文献中，肿瘤细胞有含铁血黄素色素沉着的神经上皮肿瘤实例鲜有记载。据我们所知，这是首例报告的表现为广泛细胞内含铁血黄素沉积的色素性毛细胞型星形细胞瘤病例。
