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目的探讨胶质肉瘤(GS)的病理形态学、诊断与鉴别诊断。方法收集5例胶质肉瘤,应用光镜观察、网织纤维染色、免疫组化Max Vision法进行分析。结果 5例胶质肉瘤中男性1例,女性4例;平均年龄55岁。发病症状主要为行为改变、头晕、头痛及呕吐等。影像学显示等T2等T1的囊实性占位病变,瘤周水肿,呈环形或花边状不均匀异常强化。组织形态上,5例均以肉瘤成分为主,4例主要为纤维肉瘤,1例伴骨组织分化。胶质成分呈多灶片状散布于肉瘤成分中,组织学分级高。免疫组化:Ki-67阳性指数10%~60%,胶质成分GFAP、Oligo-2(+),IDH-1(-)。3例p16(+)、EGFR(+),1例MGMT(+)。网织纤维染色均(+)。结论胶质肉瘤是IDH野生型胶质母细胞瘤的一种亚型,同时具有胶质与肉瘤成分,预后、治疗与胶质母细胞瘤相似。
Objective To investigate the pathomorphology, diagnosis and differential diagnosis of glioma sarcoma (GS). Methods Collected 5 cases of glioma sarcoma, using light microscopy, reticulocyte staining, immunohistochemistry Max Vision method for analysis. Results 5 cases of glioma sarcoma in 1 case, 4 females; average age 55 years old. Symptoms mainly for behavioral changes, dizziness, headache and vomiting. Imaging T2 and other T1 showed cystic solid lesions, peritumoral edema, showed a ring or lace-like uneven anomalies. Morphology, 5 cases were mainly sarcoma components, 4 cases of fibrosarcoma, 1 case with bone tissue differentiation. Gels were multi-focal distribution of components in the sarcoma composition, high histological grade. Immunohistochemistry: Ki-67 positive index of 10% to 60%, glial components of GFAP, Oligo-2 (+), IDH-1 (-). 3 cases of p16 (+), EGFR (+) and 1 case of MGMT (+). Mesh fiber dyeing are (+). Conclusion Gliosarcoma is a subtype of wild-type glioblastoma in IDH with glial and sarcoma components. The prognosis and treatment are similar to those of glioblastoma.