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女性,35岁,头痛、呕吐伴行走不稳两月入院。CT示小脑蚓部占位,突入四脑室。手术切除肿瘤,病理诊断:星形细胞瘤Ⅲ级,瘤组织内可见瘤巨细胞、坏死灶、血管及血管内皮细胞增生,伴有少枝胶质细胞。术后症状缓解。继行脑局部~(60)Co放疗。8个月后出现双下肢乏力,胸背酸痛,大小便障碍。椎管造影见T_(4～9)有三处充盈缺损。头颅CT检查未见脑部肿瘤复发征象。椎管检查见T_(4～7)脊髓表面间断性鱼肉样改变,搏动消失,部分蛛网膜粘连呈白色。T_6处肿瘤活检示星形细胞瘤Ⅲ级。 讨论 星形细胞瘤播散少见,诊断标准未定。Weiss 1955年提出诊断脑胶质瘤转移的4个标准:1.组织学证实中枢
Female, 35 years old, headache, vomiting with unstable walking two months admitted. CT showed cerebellar vermis space occupying, into the fourth ventricle. Surgical removal of the tumor, pathological diagnosis: grade III astrocytoma, tumor tissue visible tumor giant cells, necrotic lesions, blood vessels and vascular endothelial cell proliferation, accompanied by oligodendrocyte. Postoperative symptoms were relieved. Followed by brain local ~ (60) Co radiotherapy. 8 months after the emergence of lower extremity fatigue, chest and back pain, urine problems. Spinal angiography see T_ (4 ~ 9) there are three filling defect. Head CT examination showed no signs of brain tumor recurrence. Spinal examination showed T_ (4 ~ 7) spinal cord surface intermittent changes in fish-like, pulsation disappeared, part of the arachnoid adhesion was white. T6 tumor biopsy showed astrocytoma grade III. Discussion Astrocytoma disseminated rare, diagnostic criteria undetermined. Weiss in 1955 proposed four criteria for the diagnosis of glioma metastasis: 1. Histology confirmed that the center