患者,女,45岁,头痛头晕伴全身乏力4月

2020-05-13 影像园 影像园

患者,女,45岁,头痛头晕伴全身乏力4月

【所属科室】

神经外科

【基本资料】

患者,女,45岁

【主诉】

头痛头晕伴全身乏力4月

【体格检查】

T36.7℃ P81次/分 R19次/分 BP121/70mmHg,疼痛评分:1分,记忆力、计算力下降。甲状腺可触及肿大。

【影像图片】

 

【影像表现】

右侧颞叶见不规则形异常信号,T1WI呈低信号,T2WI呈高信号,水抑制成像呈不均匀高信号,大小约5.7x7.0x5.1cm,增强扫描后呈轻度不均匀强化。右侧脑室及脑干明显受压变小,中线结构向左侧移位。

【病理结果】

少突胶质细胞瘤 WHO II级

【本例分析】

患者中年女性,病灶位颞叶,灶周水肿不明显,脑内肿瘤胶质瘤常见,增强扫描呈轻度强化,提示肿瘤为低级别,结合发病部位应考虑到少突胶质细胞瘤、多形性黄色星形细胞瘤、低级别弥漫性星形细胞瘤、节细胞胶质瘤等,多形性黄色星形细胞瘤和节细胞胶质瘤发病年龄较小,特别是好发于儿童和青年;多形性黄色星形细胞瘤可见脑膜强化;低级别弥漫性星形细胞瘤主要累及白质,很少累及灰质。

【小结】

少突胶质细胞瘤占颅内肿瘤的1.3~4.4%,为颅内最易发生钙化的脑肿瘤之一。绝大多数发生在幕上,以额叶为多,其次是顶叶和颞叶。少突胶质细胞瘤分为低级别少突胶质瘤(Ⅱ级)和间变型少突胶质瘤(Ⅲ级),两者的差别在于后者常见核分裂、血管增生或者坏死。本病好发于成人,多见于男性,病程缓慢。癫痫发作是最常见的临床表现,且通常为首发症状,其他临床症状包括头痛伴持续性颅内压增高等。

CT表现:多呈类圆形,边界不清楚,密度不均,囊变区呈低密度,钙化是少突胶质细胞瘤的特点,瘤周水肿轻,占位效应轻。

MRI表现:多数肿瘤轮廓清晰,水肿轻微。Ⅱ级在T1WI上表现为低、等混杂信号,T2WI上表现为高信号。钙化明显,少数有囊变出血。增强扫描多表现为斑片状轻度到中度强化;Ⅲ级在T1WI多为低信号,在T2WI上多为高信号,有明显的囊变,出血。增强扫描多表现为斑片状轻度到中度强化。

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    2021-01-21 zhmscau
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    2020-05-15 sjzlzc007
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    2020-05-15 徐岩

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