Kobayashi Tadao K, Bamba Masamichi, Ueda Masami, Nishino Toshihiro, Muramatsu Mitsue, Hino Akihiko, Shima Ayako, Echigo Tadashi, Oka Hideki
Department of Laboratory Medicine, Saiseikai Shiga Hospital, Imperial Gift Foundation Inc., Ritto, Shiga, Japan.
Acta Cytol. 2010 Mar-Apr;54(2):209-13. doi: 10.1159/000325012.
Central neurocytoma is a rare central nervous system tumor typically found in the lateral ventricles and at the spectrum pellucidum. Two patients with central neurocytoma underwent intraoperative frozen section diagnoses, and the cytologic evaluations are described.
Case 1 was a 21-year-old female who complained about reduced visual acuity. Magnetic resonance imaging (MRI) showed enhancement of a ventricular tumor. Over 80% of the tumor was removed, but after 14 months' follow-up, the disease progressed and regrowth occurred. The patient had a second tumor resection with gamma knife surgery. Case 2 was a 30-year-old female who presented with headaches. An MRI showed an enhancement of a ventricular tumor, and complete tumor removal was achieved. Cellular samples of both cases typically revealed ill-defined cytoplarm, oval nuclei with finely granular chromatin and micronucleoli. A fibrillose matrix in the background was noted. A typical appearance of perinuclear halo was also recognized. In both cases histopathologic examination was consistent with a central neurocytoma. Immunohistochemistry of both tumors was synaptophysin(+), NSE (+), NeuN(+), GFAP(-), but MIB-1 labeling index was 3.4% in case 1 and 1.1% in case 2.
These are 2 illustrative cases in which the authors report cytologic evaluation of central neurocytomna in intraoperative preparations. These tumors possess distinct cellular features that help with the intraoperative distinction from other intraventricular tumors. Moreover, it should be emphasized that immunostains for neural markers are essential for distinguishing them from other clear cell tumors of the brain, especially oligodendroglioma and clear cell ependymomal neoplasm. A combination of imaging, cytomorphology and immunohistochemical features of central neurocytoma can help to differentiate this condition from other intraventricular tumors. It is thought that careful scrutiny of intraoperative preparations allows one to make a distinction.
中枢神经细胞瘤是一种罕见的中枢神经系统肿瘤，通常位于侧脑室和透明隔。两名中枢神经细胞瘤患者接受了术中冰冻切片诊断，并对其细胞学评估进行了描述。
病例1为一名21岁女性，主诉视力下降。磁共振成像（MRI）显示脑室肿瘤有强化。肿瘤切除超过80%，但随访14个月后，疾病进展且肿瘤复发。患者接受了第二次肿瘤切除及伽马刀手术。病例2为一名30岁女性，表现为头痛。MRI显示脑室肿瘤有强化，肿瘤被完整切除。两例的细胞样本通常显示细胞质界限不清，椭圆形细胞核，染色质细颗粒状，有微小核仁。注意到背景中有纤维状基质。还识别出典型的核周晕外观。两例的组织病理学检查均符合中枢神经细胞瘤。两例肿瘤的免疫组化结果均为突触素（+）、神经元特异性烯醇化酶（+）、神经元细胞核抗原（+）、胶质纤维酸性蛋白（-），但病例1的MIB-1标记指数为3.4%，病例2为1.1%。
本文报告了2例中枢神经细胞瘤术中细胞学评估的典型病例。这些肿瘤具有独特的细胞特征，有助于术中与其他脑室肿瘤相鉴别。此外，应强调的是，神经标志物免疫染色对于将它们与脑内其他透明细胞肿瘤，尤其是少突胶质细胞瘤和透明细胞室管膜肿瘤相鉴别至关重要。中枢神经细胞瘤的影像学、细胞形态学和免疫组化特征相结合有助于将这种疾病与其他脑室肿瘤区分开来。认为仔细检查术中标本有助于做出鉴别。
