摘要：

目的 回顾1 例腺样型胶质母细胞瘤患者的诊断与治疗经过，总结此类肿瘤的组织病理学特征及诊断与鉴别诊断要点。 方法与结果 男性患者，63 岁，临床表现为口角左偏10 余天。头部MRI增强扫描提示左侧额颞叶占位性病变，考虑转移瘤可能性大。18F?脱氧葡萄糖（18F-FDG）PET 显像未见恶性肿瘤征象。行神经导航联合术中超声引导下左侧额颞叶占位性病变切除术，于手术显微镜下全切除病变。组织学形态观察，肿瘤细胞呈片状或巢状多中心生长，部分肿瘤区域黏液丰富；肿瘤细胞呈条索状、筛状、腺腔样或乳头状排列；肿瘤细胞胞质较少，胞核大小较一致、呈圆形或卵圆形、核深染，偶见明显核仁；可见肾小球样血管内皮细胞增生。免疫组织化学染色，肿瘤细胞胞质弥漫性表达胶质纤维酸性蛋白、波形蛋白和同源性磷酸酶?张力蛋白，胞核表达少突胶质细胞转录因子2 和P53，胞质和胞核表达S-100蛋白，胞膜表达表皮生长因子受体，不表达细胞角蛋白、上皮膜抗原、癌胚抗原、甲状腺转录因子-1、CD31、CD34、CAM5.2和异柠檬酸脱氢酶1，Ki-67 抗原标记指数约为76.80%。最终病理诊断为腺样型胶质母细胞瘤。术后12 d 因呼吸功能和循环功能衰竭死亡。 结论 腺样型胶质母细胞瘤临床极为罕见，明确诊断依靠特异性组织形态学特征和免疫组织化学染色。应注意与转移性腺癌相鉴别。

关键词: 胶质母细胞瘤, 免疫组织化学, 病理学

Abstract:

Objective  To report the diagnosis and treatment of one case of adenoid glioblastoma and investigate the clinicopathological features, diagnosis and differential diagnosis.  Methods and Results  A 63-year-old male patient suffered from left-skewed corner of the mouth for more than 10 d. Brain enhanced MRI revealed a cystic mass in left frontotemporal lobe and metastatic tumor was considered. 18F-fluoro-2-deoxy-D-glucose (18F-FDG) PET did not detected any sign of malignant neoplasm in the whole body. Under the guide of neuronavigation and ultrasound, the tumor was totally removed under microscope. Histologically, the tumor was located in brain parenchyma and presented a growing pattern of multicentric sheets or nests. Mucus scattered in some regions. Tumor cells were arranged in strip, cribriform, adenoid or papillary patterns. Tumor cells contained few cytoplasm with round or oval uniform hyperchromatic nuclei and occasionally obvious nucleoli. Proliferation of glomeruloid vascular endothelial cells could be seen. Immunohistochemical staining showed the cytoplasm of tumor cells was diffusively positive for glial fibrillary acidic protein (GFAP), vimentin (Vim) and phosphatase and tensin homologue (PTEN); nuclei was positive for oligodendrocytes transcription factor-2 (Olig-2) and P53; cytoplasm and nuclei were positive for S-100 protein (S-100); membrane was positive for epidermal growth factor receptor (EGFR). The tumor cells showed a negative reaction for cytokeratin (CK), epithelial membrane antigen (EMA), carcinoembryonic antigen (CEA), thyroid transcription factor-1 (TTF-1), CD31, CD34, CAM5.2 and isocitrate dehydrogenase 1 (IDH1). Ki-67 labeling index was 76.80%. The final pathological diagnosis was adenoid glioblastoma. The patient died of respiratroy failure and circulation function failure 12 d after operation.  Conclusions  Adenoid glioblastoma was a rare glioblastoma subtype. A clear diagnosis depends on histological findings and immunohistochemical features. It should be differentiated from metastatic adenocarcinoma.

Key words: Glioblastoma, Immunohistochemistry, Pathology