脑外科专家 顾建文教授

    星形细胞瘤是中枢神经系统中最常见的肿瘤类型。临床上经常会遇到患者的家属问我，“这种肿瘤是良性还是恶性的？”而用病理分级的办法来回答他们的问题，往往效果并不是很好。事实上，即便是很多临床医生，就这个问题，心里也不是十分清楚。在最新的WHO 2007 中枢神经系统肿瘤的分级中，关于肿瘤的良恶性而言，采用了肿瘤类疾病的国际分类标准代码（Morphology Code of International Classification of Diseases for Ocology,ICD-O），即0，1和3,其中0代表良性的肿瘤(Benign)，3代表恶性肿瘤(Malignant)，而1则代表肿瘤的生物性活性不确定(Borderline or uncertain behaviour)，即肿瘤的性质介于良、恶性之间。根据这个标准，在其对星形细胞瘤的分级中，其中级别最低的毛细胞性星形细胞瘤（Pilocytic astrocytoma）和室管膜下巨细胞性星形细胞瘤（Subependymal giant cell astrocytoma）均被ICD-O 分为1类肿瘤，也就是说此类肿瘤的并非真正意义上的良性肿瘤，而是生物活性会趋向于恶性肿瘤的肿瘤。以此类推，在被WHO分级中的II级以上的星形细胞瘤的性质则更加偏向恶性肿瘤。所以，我在和患者谈话的时候，如果肿瘤的病理报告中肿瘤的级别为II级以上，我会告诉家属，肿瘤是恶性的，如果是I级，我会告诉家属，肿瘤有可能是恶性，术后的辅助治疗（放疗或者化疗是必须的）。

同时附以WHO 2007 中枢神经系统的分级表。

Table 1 The 2007 WHO ClassiWcation of Tumours of the Central Nervous System.

TUMOURS OF NEUROEPITHELIAL TISSUE
Astrocytic tumours
Pilocytic astrocytoma 9421/1 （斜线后的0、1、3 即为ICD-O）
Pilomyxoid astrocytoma 9425/3*
Subependymal giant cell astrocytoma 9384/1
Pleomorphic xanthoastrocytoma 9424/3
Diffuse astrocytoma 9400/3
Fibrillary astrocytoma 9420/3
Gemistocytic astrocytoma 9411/3
Protoplasmic astrocytoma 9410/3
Anaplastic astrocytoma 9401/3
Glioblastoma 9440/3
Giant cell glioblastoma 9441/3
Gliosarcoma 9442/3
Gliomatosis cerebri 9381/3
Oligodendroglial tumours
Oligodendroglioma 9450/3
Anaplastic oligodendroglioma 9451/3
Oligoastrocytic tumours
Oligoastrocytoma 9382/3
Anaplastic oligoastrocytoma 9382/3
Ependymal tumours
Subependymoma 9383/1
Myxopapillary ependymoma 9394/1
Ependymoma 9391/3
Cellular 9391/3
Papillary 9393/3
Clear cell 9391/3
Tanycytic 9391/3
Anaplastic ependymoma 9392/3
Choroid plexus tumours
Choroid plexus papilloma 9390/0
Atypical choroid plexus papilloma 9390/1*
Choroid plexus carcinoma 9390/3
Other neuroepithelial tumours
Astroblastoma 9430/3
Chordoid glioma of the third ventricle 9444/1
Angiocentric glioma 9431/1*
Neuronal and mixed neuronal-glial tumours
Dysplastic gangliocytoma of cerebellum
(Lhermitte-Duclos) 9493/0
Desmoplastic infantile astrocytoma/
ganglioglioma 9412/1
Dysembryoplastic neuroepithelial tumour 9413/0
Gangliocytoma 9492/0
Ganglioglioma 9505/1
Anaplastic ganglioglioma 9505/3
Central neurocytoma 9506/1
Extraventricular neurocytoma 9506/1*
Cerebellar liponeurocytoma 9506/1*
Papillary glioneuronal tumour 9509/1*
Rosette-forming glioneuronal tumour
of the fourth ventricle 9509/1*
Paraganglioma 8680/1
Tumours of the pineal region
Pineocytoma 9361/1
Pineal parenchymal tumour of
intermediate differentiation 9362/3
Pineoblastoma 9362/3
Papillary tumour of the pineal region 9395/3*
Embryonal tumours
Medulloblastoma 9470/3
Desmoplastic/nodular medulloblastoma 9471/3
Medulloblastoma with extensive
nodularity 9471/3*
Anaplastic medulloblastoma 9474/3*
Large cell medulloblastoma 9474/3
CNS primitive neuroectodermal tumour 9473/3
CNS Neuroblastoma 9500/3
CNS Ganglioneuroblastoma 9490/3
Medulloepithelioma 9501/3
Ependymoblastoma 9392/3
Atypical teratoid / rhabdoid tumour 9508/3
TUMOURS OF CRANIAL AND PARASPINAL
NERVES
Schwannoma (neurilemoma, neurinoma) 9560/0
Cellular 9560/0
Plexiform 9560/0
Melanotic 9560/0
Neurofibroma 9540/0
Plexiform 9550/0
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