松果体区乳头状肿瘤伴软脑膜播散。

Papillary tumor of pineal region presenting with leptomeningeal seeding.

机构信息

Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea.

出版信息

Neuropathology. 2010 Dec;30(6):654-60. doi: 10.1111/j.1440-1789.2010.01108.x.

Abstract

Papillary tumor of the pineal region (PTPR) is a recently recognized and rare pineal tumor, presenting as a solitary mass with or without hydrocephalus. Here, we report a case of c-Kit expressing PTPR with leptomeningeal seeding. A 39-year-old woman presented with a 1-month history of headache and decreased visual acuity. MRI showed a large, 4 cm-diameter solid and cystic enhancing mass at the pineal region with associated ventriculomegaly. Smaller nodular lesions were also found at the pituitary stalk and bilateral internal acoustic canal (IAC). The leptomeninges were noted to be enhanced with gadolinium. Endoscopic third ventriculostomy and partial resection were performed. The specimen was small in quantity but nonetheless, revealed the typical features of PTPR, which were tumor cells with vacuolated cytoplasm forming a pseudopapillary architecture. The tumor cells were diffusely immunoreactive for vimentin, INI-1 and c-Kit, focally immunoreactive for neuronal specific enolase (NSE) and S100 protein but negative for cytokeratin, epithelial membrane antigen (EMA), synaptophysin and GFAP. Ultrastructurally, the tumor cells revealed variably-sized cytoplasmic vacuoles, intermediate filaments and villous cytoplasmic membrane. With these features, a diagnosis of PTPR was rendered. The lesions at the pineal gland and bilateral IAC were irradiated through gamma knife radiosurgery and a decrease in size of the lesions was noted on follow-up MRI. However, soon after, other lesions were also noted to develop along the adjacent sites. The case presented is proof that PTPR can disseminate to other sites distant from the original lesion. This case was a c-kit expressing PTPR, which might represent the more primitive nature of this tumor. Ultrastructural examination is useful to differentiate PTPR from other tumors of the pineal gland in addition to immunohistochemistry.

摘要

松果体区乳头状肿瘤(PTPR)是一种新近认识到的罕见的松果体肿瘤,表现为单发肿块,伴有或不伴有脑积水。在此,我们报告一例 c-Kit 表达的 PTPR 伴脑膜播散。一名 39 岁女性因头痛和视力下降 1 个月就诊。MRI 显示松果体区有一个 4 厘米直径的大的实性和囊性强化肿块,伴有脑室扩大。还发现垂体柄和双侧内听道(IAC)有小结节病变。脑膜呈钆增强。行内镜第三脑室造瘘术和部分切除术。标本数量少,但仍显示出 PTPR 的典型特征,即肿瘤细胞有空泡状细胞质,形成假乳头状结构。肿瘤细胞弥漫性表达波形蛋白、INI-1 和 c-Kit,局灶性表达神经元特异性烯醇化酶(NSE)和 S100 蛋白,但不表达细胞角蛋白、上皮膜抗原(EMA)、突触素和 GFAP。电镜下,肿瘤细胞显示大小不一的细胞质空泡、中间丝和绒毛状细胞质膜。根据这些特征,诊断为 PTPR。松果体和双侧 IAC 的病变通过伽玛刀放射外科进行照射,随访 MRI 显示病变缩小。然而,不久后,还发现其他病变也沿着相邻部位发展。本例证明 PTPR 可以播散到远离原发病灶的其他部位。本例为 c-Kit 表达的 PTPR,可能代表该肿瘤更原始的性质。除免疫组化外,电镜检查有助于将 PTPR 与松果体的其他肿瘤区分开来。

文献AI研究员

20分钟写一篇综述,助力文献阅读效率提升50倍

立即体验

用中文搜PubMed

大模型驱动的PubMed中文搜索引擎

马上搜索