Salazar Miguel Fdo, Tena-Suck Martha Lilia, Ortiz-Plata Alma, Salinas-Lara Citlaltepetl, Rembao-Bojórquez Daniel
Department of Neuropathology, National Institute of Neurology & Neurosurgery "Manuel Velasco Suárez", Tlalpan, Mexico City, Mexico.
Laboratory of Experimental Neuropathology, National Institute of Neurology & Neurosurgery "Manuel Velasco Suárez", Tlalpan, Mexico City, Mexico.
Case Rep Pathol. 2017;2017:8617050. doi: 10.1155/2017/8617050. Epub 2017 Feb 14.
"Lipomatous" and "extensively vacuolated" are descriptive captions that have been used to portray a curious subset of ependymomas distinctively bearing cells with a large vacuole pushing the nucleus to the periphery and, thus, simulating a signet-ring cell appearance. Here, we would like to report the first ependymoma of this kind in a Latin American institution. A 16-year-old boy experienced cephalea during three months. Magnetic resonance imaging scans showed a left paraventricular tumour which corresponded to anaplastic ependymoma. Intriguingly, it was also composed of cells with single or multiple hollow cytoplasmic vacuoles sometimes giving a signet-ring cell-like configuration. Immunolabeling of these showed membrane positivity for GFAP, PS100, and CD99, while Ki-67 expression was null. Ultrastructural examination of retrieved paraffin-embedded tissue showed the presence of scarce microlumina filled with microvilli but failed to demonstrate any content in such optically empty vacuoles as only scant granulofibrillary debris was observed. A schism prevails at present regarding these unusual morphological variants, being either "lipomatous" or "vacuolated" based mainly on the EMA immunoprofile. This, however, is a misappropriate approaching. Could it be that perhaps we are dealing with the same histopathological entity or it may simply happen that fixation and artefacts cannot allow for their proper identification?
“脂肪瘤样”和“广泛空泡化”是用于描述室管膜瘤中一个奇特亚群的描述性标题，该亚群的细胞具有大空泡，将细胞核推向周边，从而模拟印戒样细胞外观。在此，我们报告拉丁美洲一家机构首例此类室管膜瘤。一名16岁男孩在三个月内出现头痛。磁共振成像扫描显示左脑室旁肿瘤，符合间变性室管膜瘤。有趣的是，它也由具有单个或多个中空细胞质空泡的细胞组成，有时呈现印戒样细胞形态。这些细胞的免疫标记显示GFAP、PS100和CD99呈膜阳性，而Ki-67表达为阴性。对获取的石蜡包埋组织进行超微结构检查，发现存在少量充满微绒毛的微管腔，但在这些光学上为空的空泡中未发现任何内容物，仅观察到少量颗粒状纤维碎片。目前对于这些不寻常的形态学变异存在分歧，主要根据EMA免疫表型将其分为“脂肪瘤样”或“空泡化”。然而，这是一种不恰当的方法。难道我们处理的可能是同一组织病理学实体，或者仅仅是固定和人为因素不允许对其进行正确识别？
