Lesional-mixture of large cells and robust lymphocytic inflammation. No discrete granuloma. some old hemorrhage. Favour germinoma. Need another biopsy for pernanents.
MICROSCOPIC EXANINATION
Sections show a lesional process characterized by a mixture of cells with aggregates and small groups of larger tumour cells characterized as somewhat polygonal cells with prominent nuclei and nucleoli. These are interningled and surrounded by abundant likely reactive smaller mononuclear cells chiefly lymphocytes with probably some admixed histiocytes or macrophages. There is no discrete granuloma formation. There is no tissue necrosis. Eosinophils are not evident.
With the immunohistochemistry, there is multifocal positivity throughout the lesion for CD117(CKIT) in the larger tumour cells described. A similar pattern is seen for placental alkaline phosphatase. Alpha-fetoprotein and beta HCG are immunonegative. There is very robust T-lymphocytic reactive inflammatory process highlighted with CD3 immunopositivity. Ki-67 shows a signigicant proliferation and CD68 also shows a robust intermingled macrophage inflammatory reaction.
活检结果:
FROZEN SECTION
Lesional-mixture of large cells and robust lymphocytic inflammation. No discrete granuloma. some old hemorrhage. Favour germinoma. Need another biopsy for pernanents.
MICROSCOPIC EXANINATION
Sections show a lesional process characterized by a mixture of cells with aggregates and small groups of larger tumour cells characterized as somewhat polygonal cells with prominent nuclei and nucleoli. These are interningled and surrounded by abundant likely reactive smaller mononuclear cells chiefly lymphocytes with probably some admixed histiocytes or macrophages. There is no discrete granuloma formation. There is no tissue necrosis. Eosinophils are not evident.
With the immunohistochemistry, there is multifocal positivity throughout the lesion for CD117(CKIT) in the larger tumour cells described. A similar pattern is seen for placental alkaline phosphatase. Alpha-fetoprotein and beta HCG are immunonegative. There is very robust T-lymphocytic reactive inflammatory process highlighted with CD3 immunopositivity. Ki-67 shows a signigicant proliferation and CD68 also shows a robust intermingled macrophage inflammatory reaction.
Favour 就是可能的意思。剩下的没有意义。换句话说，
没有形成单独的癌块。一切均在生长之中。
DIAGNOSIS
A&B. Region of skull base:
-Gerninoma
Germinoma的指标性tumor marker， 但beta HCG 阴性代表治疗后复发率比较低，特别对放疗敏感。所以按医生安排治疗，愈后会比较好。
出现周围组织细胞坏死necrosis，及时治疗为要。
医生说他的计划是：
减量的化疗和减量的放疗（垂体45-60gys, 全脑室18gys). 按照这个量的话，垂体基本丧失功能，还会有其他的副作用。
清楚治疗后遗症的数据，知道几个女孩都能正常生活和成长。
意见，但我不认为有任何不同。当然你自己也有拒绝医生意见的权利。
https://www.cancer.gov/types/brain/patient/child-cns-germ-cell-treatment-pdq
著名的案例：白血病孩的家长拒绝化疗，被告上法庭，法院判必须治疗。家长带孩子逃出美国。
http://www.danafarberbostonchildrens.org/conditions/brain-tumor/germ-cell-tumors-of-the-brain.aspx
germinoma 很罕见，病例少没有统计数据正常。
建议去seek second opinion，那怕需要自己掏腰包，花钱买个放心。
2012年开始， 2016年病人收满。
https://www.childrensoncologygroup.org/index.php/acns1123
Contact InformationYour child's oncologist and nurses are the best sources for further information.
Study ChairsUte Bartels, MD
Hospital for Sick Children
Toronto, ON
COG那太有名了。https://www.google.com/search?q=children+oncology+group&oq=children+oncology+group&aqs=chrome.0.69i59j35i39j0l4.7783j0j7&sourceid=chrome&ie=UTF-8
北美， 欧洲的儿童医院肿瘤科都是COG成员，小病人都参加各种临床试验的。可惜COG不收亚洲国家，连日本都没有。美国成人肿瘤病人参加临床试验的好像只有百分之几， 可怜。
https://www.sciencedirect.com/science/article/pii/S2405630816300052