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目的探讨良性脊索细胞瘤(BNCT)的临床病理特征、诊断与鉴别诊断。方法在临床资料及影像学所见基础上,分析1例BNCT的组织病理特征并复习相关文献。结果患者女性,48岁。下腰痛1年。CT扫描显示第4腰椎椎体软骨终板下占位性病变,具有清楚的硬化边,但无明显的皮质塌陷及骨质破坏。MRI示T2WI呈高信号,而T2WI呈低信号。行病灶彻底刮除及腰椎重建术。巨检:病变呈果冻样或貌似变性的骨髓脂肪。镜检:肿瘤主要由实性片层状脂肪样细胞或洋葱皮样细胞构成,肿瘤细胞马赛克样排列,胞膜清晰,胞质空泡状、泛白或轻度嗜酸性,核圆形、卵圆形,居中或偏位。不仅无显著的核异型及核分裂,同时缺乏分叶状结构、细胞外黏液样基质及丰富的血管网,也无松质骨浸润及坏死。病变中可见一些岛状分布的非肿瘤性骨髓组织。受累骨小梁硬化。免疫组化示CKpan和CK8/18(+),但CD68(-)。结论 BNCT是一种罕见的骨内脊索源性良性肿瘤,预后良好。
Objective To investigate the clinicopathological features, diagnosis and differential diagnosis of benign spinal cord tumor (BNCT). Methods Based on the clinical data and imaging findings, one case of BNCT histopathological features and review of relevant literature. Results Patients Female, 48 years old. Low back pain for 1 year. CT scan showed the fourth lumbar vertebral cartilage end-plate lesions, with a clear sclerosis, but no obvious cortical collapse and destruction of bone. MRI showed high signal T2WI, T2WI showed a low signal. Complete curettage lesions and lumbar reconstruction. Giant check: lesions were jelly-like or seemingly degenerative bone marrow fat. Microscopic examination: Tumors mainly consist of solid lamellar adipose-like cells or onion-like cells, with mosaic arrangement of tumor cells, clear membrane, vacuolar cytoplasm, pan-whitish or mildly eosinophilic, Round, center or offset. Not only no significant nuclear atypia and mitotic division, at the same time the lack of lobular structure, extracellular mucus-like matrix and rich vascular network, but also cancellous bone infiltration and necrosis. Lesions can be seen in some island-shaped distribution of non-neoplastic bone marrow tissue. Involved trabecular bone sclerosis. Immunohistochemistry showed CKpan and CK8 / 18 (+), but CD68 (-). Conclusion BNCT is a rare bone-derived spinal benign tumor with a good prognosis.