Kang Myunghee, Kim Na Rae, Chung Dong Hae, Yoo Chan Jong
Gachon University School of Medicine, Incheon, Korea.
Acta Cytol. 2012;56(5):571-5. doi: 10.1159/000338392. Epub 2012 Sep 27.
Granular cell astrocytoma (GCA) is a rare variant of astrocytoma, characterized by an aggressive prognosis compared to conventional astrocytomas of the same World Health Organization grade. Intraoperative smears provide useful clues in diagnosing neuropathology, especially in rarely encountered central nervous system tumors.
The patient was a 53-year-old man who presented with a huge mass at the left temporal lobe with peritumoral edema on MRI. The crush smears revealed singly-scattered, large eosinophilic cells with eccentrically located nuclei as well as plump, finely-granular cytoplasm with distinct borders. Mild cellular atypia and absence of mitotic activity were noted. These cells were admixed with small mature lymphoid cells. Histology showed scattered large granular cells which were positive for glial fibrillary acidic protein.
The most helpful imprint cytologic findings of GCA were as follows: (1) large cells containing eosinophilic granular cytoplasm rather than the foamy or bubbly cytoplasm associated with macrophages or renal cell carcinomas; (2) distinct granular cell borders in contrast to the ruffled membrane of macrophages, and (3) markedly large-sized granular cells, ranging from 60 to 100 µm in diameter.
颗粒细胞型星形细胞瘤（GCA）是星形细胞瘤的一种罕见变异型，与世界卫生组织同一分级的传统星形细胞瘤相比，其预后具有侵袭性。术中涂片为神经病理学诊断提供了有用线索，尤其是在罕见的中枢神经系统肿瘤中。
患者为一名53岁男性，磁共振成像显示左颞叶有巨大肿块伴瘤周水肿。压片显示单个散在的大嗜酸性细胞，核偏位，胞质丰满、细颗粒状，边界清晰。可见轻度细胞异型性，无有丝分裂活性。这些细胞与小的成熟淋巴细胞混合存在。组织学检查显示散在的大颗粒细胞，胶质纤维酸性蛋白呈阳性。
GCA最有用的印片细胞学表现如下：（1）大细胞含有嗜酸性颗粒状胞质，而非与巨噬细胞或肾细胞癌相关的泡沫状或气泡状胞质；（2）颗粒细胞边界清晰，与巨噬细胞的皱膜不同；（3）颗粒细胞明显大，直径在60至100μm之间。
