脑胶质瘤瘤周CT低密度区的病理和超微结构研究  

Study on Pathological Changes and Ultrastructure in Peritumoral Low-density Area on CT-scan in Brain Gliomas

作　　者：林志雄[1] 王玮[2] 陈锦峰[1] 张鹏飞[2] 戴福珍 张子平[1] 

机构地区：[1]福建医科大学附属第一医院神经外科,福州350005 [2]福建医学院解剖教研室

出　　处：《中国神经免疫学和神经病学杂志》1997年第3期172-177,共6页Chinese Journal of Neuroimmunology and Neurology

摘　　要：为阐明脑胶质瘤瘤周CT低密度区（CT－PTLDA）本质及其与预后的关系，本研究对20例胶质瘤瘤周CT低密度区的宽度进行分级，并以光镜观察其病理特征；结合CT平扫及增强扫描的影像，取代表性的14例肿瘤瘤体、水肿区和正常脑组织进行电镜观察比较。结果显示：（1）CT－PTLDA内可见瘤细胞浸润；（2）电镜下可见瘤体及瘤周毛细血管内皮细胞呈不同程度肿胀，紧密连接扩张、扭曲，基膜完整但厚薄不均，胶质膜局部缺损。CT－PTLDA越宽其血脑屏障改变也越严重；（3）CT－PTLDA宽度与预后密切相关，CT－PTLDA越宽预后越差。以上结果提示脑胶质瘤CT－PTLDA是瘤细胞浸润扩散的实际范围及伴有脑水肿的表现，对CT－PTLDA宽度进行分级有助于对预后的判断。笔者建议在胶质瘤手术中应尽可能切除非功能区组织的水肿带，以免留下肿瘤复发根源。Purpose In order to demonstrate the nature of peritumoral low-density area seen on CT-scan (CT-PTLDA) and its effect on prognosis. Methods CT-PTLDA was classified and the pathological characteristics in this area of 20 patients with brain gliomas were investigated by light microscope. Basing on the image seen on nonenhanced and enhanced CT-scan, the typical specimens in 14 cases were studied with transmission electron microscope (TEM), and comparing analysis of ultrastructure between PTLDA and normal brain tissues. Results The infiltration of tumor cells could be observed in CT-PTLDA. Capillaries in tumorous area and PTLDA show swelling in different degree, and intact irregular basement membrane (BM). The local glia membrane was incomplete and swollen. The tight junction between endothelial cells was extended. These changes showed a con formation of PTLDA grade, and relation to enhanced CT image in some extent. The grade of PTLDA (Grade Ⅰ and Grade Ⅱ )was negative correlation with prognosis (P＜0.01 and P＜0.05).Conclusions The CT-PTLDA were actual region where infiltrating tumor cells were noted,with CT image of edema. The blood-brain-barrier (BBB) in PTLDA show a structural changes represented by enhanced CT image. The intact BM was one of the dominant signs for no glioma metastasis. Gradation of edema was useful for judgement of prognosis. It is suggested that hydropic area should be removed from non-functioning area of brain during operation, in order to prevent from recurring metastasis.

关 键 词：脑肿瘤 胶质瘤 CT 病理 超微结构 

分 类 号：R739.41[医药卫生—肿瘤]