Kim S H, Chang W S, Kim J P, Minn Y K, Choi J, Chang J W, Kim T S, Park Y G, Chang J H
Departments of Pathology and Neurosurgery, Neuro-Oncology Clinic and Brain Research Institute, Yonsei University College of Medicine, Seoul, Department of Neurology, Hallym University, Chuncheon, and Department of Pathology, Yonsei University, Wonju College of Medicine, Wonju, Republic of Korea.
Clin Neuropathol. 2011 Nov-Dec;30(6):328-32. doi: 10.5414/np300404.
The stereotactic brain biopsy is an essential diagnostic procedure in modern neurologic patient management. A side-cutting biopsy needle is one of the most widely used needle types. Recently we found a characteristic tissue artifact named "peripheral compressing artifact" in the brain tissues biopsied using a side-cutting needle of Leksell's system. We investigate prevalence, possible cause and its clinical implication of this type of artifact.
We examined the biopsies from 80 patients (44 cases of gliomas, 13 lymphomas, 7 germ cell tumors, 2 other tumors, 1 metastatic carcinoma, 4 non-tumorous conditions such as demyelinating disease and 8 non-diagnostic) in the stereotactic biopsy group with a suspected brain tumor, who underwent a stereotactic brain biopsy using side-cutting needle of Leksell's system. We also evaluated 16 cases of open brain biopsies without Leksell's system as a control group.
The artifact is a semi-circular or band-like tissue compression in the periphery of the biopsied tissue. This artifact was found in 30 (37.5%) out of 80 cases and 57 (11.9%) out of 477 biopsied pieces. It might be produced during rotating of the inner cannula of the biopsy needle. Histologically, it might be misinterpreted as "hypercellular", "spindle", "well circumscribed", or rarely as "pseudopalisading" especially in glioma.
Awareness of this artifact would help making the appropriate pathological diagnosis for glioma.
立体定向脑活检是现代神经科患者管理中的一项重要诊断程序。侧切活检针是使用最广泛的针型之一。最近，我们在使用Leksell系统的侧切针进行活检的脑组织中发现了一种特征性的组织伪像，称为“周边压缩伪像”。我们研究了这种伪像的发生率、可能原因及其临床意义。
我们检查了立体定向活检组中80例疑似脑肿瘤患者的活检标本（44例胶质瘤、13例淋巴瘤、7例生殖细胞瘤、2例其他肿瘤、1例转移癌、4例非肿瘤性疾病如脱髓鞘疾病以及8例未明确诊断的病例），这些患者使用Leksell系统的侧切针进行了立体定向脑活检。我们还评估了16例未使用Leksell系统的开颅脑活检病例作为对照组。
该伪像是活检组织周边的半圆形或带状组织压缩。在80例病例中有30例（37.5%）发现了这种伪像，在477块活检组织中有57块（11.9%）发现了该伪像。它可能是在活检针内套管旋转过程中产生的。在组织学上，它可能被误诊为“细胞增多”“梭形”“边界清楚”，在胶质瘤中很少被误诊为“假栅栏状”。
认识到这种伪像有助于对胶质瘤做出恰当的病理诊断。
