摘要： 目的 总结颅内静脉窦血栓形成的临床病理学特征，以减少此类疾病误诊为脑肿瘤。方法与结果 男性患者，46岁，临床主要表现为头痛伴言语不清。血浆D-二聚体升高，头部MRI显示左侧颞叶后部占位性病变并出血可能，行左侧颞叶占位性病变切除术。组织学形态观察，脑组织结构疏松、解离、坏死，皮质内灶性出血，小血管增生，神经细胞明显减少且呈缺氧性改变，胶质纤维空泡化，大量富含脂质的吞噬细胞浸润，血管周围淋巴细胞浸润，蛛网膜下腔浅静脉管腔内混合血栓形成；免疫组化染色，病灶细胞胶质纤维酸性蛋白阳性提示为反应性增生的胶质细胞，CD31阳性提示为血管内皮细胞，CD163和CD68阳性提示为组织细胞，CD3和CD20阳性提示为淋巴细胞，神经微丝蛋白阳性并可见神经轴索相对保留完好，Ki-67抗原标记指数约5%（主要为淋巴细胞阳性）；髓鞘染色未见明显髓鞘脱失。病理诊断为大脑浅静脉血栓形成；亚急性期缺血性卒中出血性转化。结论 临床应结合病史、实验室检查和影像学综合诊断颅内静脉窦血栓形成，当影像学诊断困难时，应进一步行病理学检查以明确诊断，早期诊断、及时治疗可以改善患者预后。

关键词: 窦血栓形成, 颅内, 脑肿瘤, 免疫组织化学

Abstract: Objective To investigate the clinicopathological features of cerebral venous sinus thrombosis (CVST) in order to reduce its misdiagnosis as brain tumors. Methods and Results A 46-year-old male was admitted to hospital due to headaches and inarticulate speech. Elevated levels of D-dimer detected in plasma. Head MRI suggested that it may be left temporal occipital lobe brain tumor with hemorrhage. Surgical resection of space-occupying lesions in the left temporal lobe was performed. Optical microscopy showed the structure of brain was loose, dissociated, necrosis, hemorrhage in the cortex, vessel proliferation. Neurons decreased significantly, and the remaining neurons showed hypoxic changes. Lots of foam cells infiltration, perivascular lymphocytic infiltration, mixed with thrombosis could be seen in the subarachnoid vena cava superficial vein vessel lumen. Immunohistochemical staining showed CD31 was positive indicateing vascular endothelial cells, CD163 and CD68 were positive in foam cells, glial fibrillary acidic protein (GFAP) was positive indicating reactive proliferation of glial cell, CD3 and CD20 were positive indicating lymphocyte, neurofilament protein (NF) was positive and showed that the axon was relatively well preserved. Ki-67 proliferation index was 5% (most of them were lymphocyte positive). Myelin staining showed no obvious demyelination. Final pathological diagnosis was cerebral superficial cortical vein thrombosis; subacute hemorrhagic cerebral infarction. Conclusions Diagnosis of cerebral venous sinus thrombosis requires comprehensive consideration of medical history, laboratory examinations and imaging, when imaging diagnosis is difficult, further pathological biopsy is needed to confirm the diagnosis. Early diagnosis and early treatment are beneficial to improve the patient's prognosis.

Key words: Sinus thrombosis, intracranial, Brain neoplasms, Immunohistochemistry