·臨床醫(yī)學(xué)圖像·

顱咽管瘤

圖1 成釉細(xì)胞型顱咽管瘤光學(xué)顯微鏡觀察所見×200 1a可見鱗狀上皮結(jié)構(gòu)伴周圍“柵欄”樣排列的柱狀上皮細(xì)胞，伴濕性角化物形成HE染色1b旋渦狀細(xì)胞簇胞核表達(dá)β-連環(huán)蛋白免疫組織化學(xué)染色（En Vision二步法）圖2 乳頭型顱咽管瘤光學(xué)顯微鏡觀察所見×200 2a腫瘤組織由無角化的鱗狀上皮細(xì)胞組成HE染色2b胞膜表達(dá)β-連環(huán)蛋白免疫組織化學(xué)染色（EnVision二步法）Figure 1 Optical microscopy findings of adamantinomatous craniopharyngioma×200 The squamous epithelium structure was surrounded by columnar epithelial cells in paliform arrangement,with formation of wet keratin(Panel 1a).HE staining Nuclei of whorl-like cell clusters were positive for β-catenin(Panel 1b).Immunohistochemical staining(En Vision)Figure 2 Optical microscopy findings of papillary craniopharyngioma×200 Tumor was composed of non-keratinizing squamous epithelium cells (Panel 2a).HE staining Membrane of tumor cells was positive for β-catenin(Panel 2b).Immunohistochemical staining (En Vision)

2016年世界衛(wèi)生組織（WHO）中樞神經(jīng)系統(tǒng)腫瘤分類將顱咽管瘤定義為鞍區(qū)部分囊性上皮組織良性腫瘤，推測其可能源自Rathke囊上皮組織，具有兩種臨床病理亞型，即成釉細(xì)胞型和乳頭型，二者免疫表型和特征性基因突變截然不同。約95%的成釉細(xì)胞型顱咽管瘤存在CTNNB1突變，有81%～95%的乳頭型顱咽管瘤存在BRAF V600E突變（這一突變也可采用免疫組織化學(xué)染色檢出）。成釉細(xì)胞型顱咽管瘤含條索狀、葉狀、螺紋樣結(jié)節(jié)和不規(guī)則梁狀鱗狀上皮結(jié)構(gòu)伴周圍“柵欄”樣排列的柱狀上皮細(xì)胞（圖1a），胞核表達(dá)β-連環(huán)蛋白（圖1b）；乳頭型顱咽管瘤由呈單一、緊密排列的分化良好、無角化的鱗狀上皮細(xì)胞組成（圖2a），胞膜表達(dá)β-連環(huán)蛋白（圖2b）。

（天津市環(huán)湖醫(yī)院病理科閻曉玲供稿）

Craniopharyngioma

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

10.3969/j.issn.1672-6731.2017.01.016