·臨床醫(yī)學(xué)圖像·

肥胖細(xì)胞型星形細(xì)胞瘤，IDH?突變

圖1 光學(xué)顯微鏡觀察顯示，腫瘤細(xì)胞胞質(zhì)豐富，呈嗜酸性，胞核偏位 HE染色 ×200 圖2 光學(xué)顯微鏡觀察所見 免疫組織化學(xué)染色（EnVision二步法） 2a 腫瘤細(xì)胞胞質(zhì)和胞核周圍高表達(dá)GFAP ×200 2b 胞質(zhì)高表達(dá)和胞核低表達(dá)R132H?突變的IDH1 ×400Figure 1 Opticalmicroscopy showed tumorcellshad abundant eosinophilic cytoplasm,with nuclei displaced to the periphery. HE staining × 200 Figure 2 Optical microscopy findings Immunohistochemical staining(EnVision) Tumor cells were strongly positive for GFAP in the cytoplasm and the periphery of nuclei(Panel 2a). ×200 The cytoplasm was strongly positive and nuclei midly positive for R132H?mutant IDH1(Panel 2b). ×400

2016年世界衛(wèi)生組織（WHO）中樞神經(jīng)系統(tǒng)腫瘤分類將肥胖細(xì)胞型星形細(xì)胞瘤，IDH?突變定義為伴異檸檬酸脫氫酶1或2（IDH1或IDH2）基因突變的彌漫性星形細(xì)胞瘤的一種亞型，以存在明顯（可能數(shù)目不等）的肥胖腫瘤性星形細(xì)胞為特點。肥胖細(xì)胞約占所有腫瘤細(xì)胞的20%，在彌漫性星形細(xì)胞瘤中也可見少許肥胖細(xì)胞，但不能診斷為肥胖細(xì)胞型星形細(xì)胞瘤。采用IDH分型命名前，肥胖細(xì)胞型星形細(xì)胞瘤易進(jìn)展為間變性星形細(xì)胞瘤或繼發(fā)性膠質(zhì)母細(xì)胞瘤，但尚不清楚肥胖細(xì)胞型星形細(xì)胞瘤，IDH?突變是否更易惡性進(jìn)展。組織學(xué)形態(tài)特點是肥胖腫瘤性星形細(xì)胞呈角狀，具有豐富的毛玻璃樣嗜酸性胞質(zhì)，肥胖、無方向的胞突形成致密纖維網(wǎng)，胞核形狀怪異、偏位，可見小核仁，染色質(zhì)濃染（圖1），常見血管周圍淋巴細(xì)胞“袖套”形成。免疫組織化學(xué)染色，腫瘤細(xì)胞胞質(zhì)和胞核周圍高表達(dá)膠質(zhì)纖維酸性蛋白（GFAP，圖2a），胞質(zhì)高表達(dá)和胞核低表達(dá)R132H?突變的IDH1（圖2b），胞核表達(dá)P53。

（天津市環(huán)湖醫(yī)院病理科閻曉玲供稿）

Gemistocytic astrocytoma,IDH?mutant

YAN Xiao?ling
Department of Pathology,Tianjin Huanhu Hospital,Tianjin 300350,China(Email:ll934065@126.com)

10.3969/j.issn.1672?6731.2017.10.013