肺转移性脑膜瘤四例临床分析  

Pulmonary metastases from meningioma:a clinical analysis of 4 cases

作　　者：邓桃[1] 周胜理 张雷[1] 李博[2] 李明[3] 魏建国[4] 王席娟[5] 赵跃武[1] 孔令非[1] 赵瑞皎[1] Deng Tao;Zhou Shengli;Zhang Lei;Li Bo;Li Ming;Wei Jianguo;Wang Xijuan;Zhao Yuewu;Kong Lingfei;Zhao Ruijiao(Department of Pathology,Henan Provincial People’s Hospital,Zhengzhou 450003,China;Department of Radiology,Henan Provincial People’s Hospital,Zhengzhou 450003,China;Department of Neurosurgery,Henan Provincial People’s Hospital,Zhengzhou 450003,China;Department of Pathology,Shaoxing People’s Hospital,Shaoxing 312000,China;Department of Neonatology,Henan Provincial People’s Hospital,Zhengzhou 450003,China)

机构地区：[1]河南省人民医院病理科,郑州450003 [2]河南省人民医院核医学科,郑州450003 [3]河南省人民医院神经外科,郑州450003 [4]绍兴市人民医院病理科,绍兴312000 [5]河南省人民医院新生儿科,郑州450003

出　　处：《中国实用医刊》2023年第7期1-4,共4页Chinese Journal of Practical Medicine

基　　金：国家自然科学基金(82172761)

摘　　要：目的探讨肺转移性脑膜瘤的临床病理特征、免疫表型,为其临床诊断提供参考。方法抽取河南省人民医院2000年1月至2021年12月收治的肺转移性脑膜瘤患者4例,均经病理检查确诊,对其临床资料进行回顾性分析。结果4例患者中男2例,女2例,患病年龄45~57岁,平均53岁。4例患者均有颅内脑膜瘤病史。影像学检查结果提示肺部多发结节,考虑转移瘤可能。肉眼观肿瘤最大径0.2~3.0 cm,均为多发结节,色灰白,质略韧,与周围肺组织界限清楚。镜下示肿瘤由片状梭形/卵圆形细胞构成,胞浆丰富嗜酸,局灶细胞生长活跃。其中2例患者肺部转移灶和颅内原发灶相比,肿瘤细胞密度增加,核浆比增大,核分裂像约3~4个/10个高倍视野,但未见明确坏死,免疫组化示上皮膜抗原(EMA)和孕激素受体(PR)阳性,诊断为非典型性脑膜瘤。另外2例肺内转移灶和颅内原发灶镜下形态基本相似,诊断为转移性脑膜瘤。至末次随访,4例患者均存活。结论肺转移性脑膜瘤非常罕见,颅内脑膜瘤病史、临床病理学检查及EMA和PR免疫组化染色有助于诊断。Objective To investigate the clinicopathological characteristics,immunophenotype of pulmonary metastases from meningioma,and provide reference for clinical diagnosis.Methods Four patients with pulmonary metastases from meningioma admitted to Henan Provincial People’s Hospital from January 2000 to December 2021 were selected,and they were definitely diagnosed by pathology.The clinical data of the 4 cases pulmonary metastases from meningioma were retrospectively analyzed.Results There were 2 males and 2 females among the 4 patients,with the average age of 53 years(ranged from 45 years to 57 years).All of the 4 patients had a history of intracranial meningiomas.Results of imaging examination showed that there were multiple nodules in the lung,considering the possibility of metastasis.Gross inspection showed that multiple nodules had a major diameter ranged from 0.2 cm to 3.0 cm,manifesting greyish and slightly tough,with clear boundary with the surrounding lung tissue.The microscope showed that the tumor was composed of spindle or oval cells,with rich eosinophilic cytoplasm and focal cells.In 2 of the 4 patients,compared with the primary intracranial lesions,the pulmonary metastases showed increased tumor cell density,increased nuclear plasma ratio,and about 3-4 mitoses per 10 high power field,but no definite necrosis;and immunohistochemistry showed epithelial membrane antigen(EMA)and progesterone receptor(PR)positive;the 2 cases were diagnosed as atypical meningioma.In the other 2 cases,the morphology of pulmonary metastases and intracranial primary lesions were basically similar under microscope,and the 2 cases were diagnosed as metastatic meningioma.Up to the last follow-up,all 4 cases survived.Conclusions Pulmonary metastasis from meningioma is very rare.The history of intracranial meningiomas,clinical pathological examination,EMA and PR immunohistochemical staining could be helpful for diagnosis.

关 键 词：脑膜瘤 肺转移 临床病理特征 

分 类 号：R734.2[医药卫生—肿瘤]