脊索样脑膜瘤四例临床病理分析  

Chordoid meningoma:a clinical and pathological study of 4 cases

作　　者：董莉[1] 董驰[1] 周俊林[2] 袁治[3] 张虹[1] 

机构地区：[1]兰州大学第二医院病理科,甘肃兰州730030 [2]兰州大学第二医院放射科,甘肃兰州730030 [3]兰州大学第二医院神经外科,甘肃兰州730030

出　　处：《中华肿瘤防治杂志》2017年第16期1166-1169,1174,共5页Chinese Journal of Cancer Prevention and Treatment

摘　　要：目的作为脑膜瘤的一种罕见亚型,脊索样脑膜瘤因不具备典型脑膜瘤的病理特征,常难以同脊索瘤及其他肿瘤区分,易造成误诊。本研究旨在通过探讨脊索样脑膜瘤临床病理特征、免疫表型及MRI特征表现,进一步提高对该亚型脑膜瘤的认识。方法收集兰州大学第二医院2010-10-01—2015-10-25经手术后病理确诊的4例脊索样脑膜瘤患者临床资料,分析临床病理特征及影像资料,结合相关文献进行对比研究。结果光镜下,4例HE染色示组织学类似脊索瘤,瘤组织排列成束状或小梁状分布于黏液样基质中,瘤细胞胞质丰富,嗜酸,并可见胞质内空泡,部分区域为典型脑膜瘤漩涡状、束状、编织状结构,2例瘤组织间可见少量淋巴细胞、浆细胞浸润。免疫表型示,瘤细胞EMA(+)、Vimentin(+)、CKp(-)、S-100(-)、GFAP(-),Ki-67阳性细胞数平均为8%。MRI示,4例均为单发病灶,3例位于顶叶,1例位于额颞叶;2例为实性类圆形,1例呈不规则团块状,1例为囊实性,实性呈结节状附壁生长;2例病灶界限不清,2例边界清晰;4例瘤周水肿明显,邻近脑组织均有不同程度受累;T1WI 4例呈等、略低信号;T2WI 3例呈等、略高信号,1例呈等、略低信号。结论诊断脊索样脑膜瘤,应结合形态学、相应的免疫组化染色及具有一定表现特征的影像学检查,以有效降低误诊率。OBJETIVE As the rare subtype of meningioma, chordoid meningioma does not have the typical characteristics of meningioma, it is easily confused with chordoma and other tumor, which leads to misdiagnosis frequently. The present study aimed to investigate the clinical and pathological characteristics, immunophenotypes and MRI manifestations of chordoid menin- goma in order to improve the existing understanding about it. METHODS From October 1, 2010 to October 25, 2015, the clin ical and pathological characteristics and MRI data of 4 cases of chordoid meningoma proved by postoperative pathology in Lanzhou University Second Hospital were comprehensively analyzed, and the comparative study was carried out with relative research re views. RESULTS Pathological results showed the diverse histological components in the 4 cases and tumor cells with abundant cytoplasm and intracytoplasmic vacuoles arranged in trabecula or bundle in the mucoid matrix. The cytoplasm was oxychromatic and the typical swirl like, fibrous-like or bundle-like structures were seen in part of tumor tissue. A few infiltration of lymphocyt ic and plasma cells were also identified in local focus in 2 cases. Immunohistochemical examination showed that the tumor cells were positive with EMA and Vimentin, but negative with CKp, S-100 and GFAP. The average proportion of Ki-67 positive cells was 8 %. MRI imaging showed that all lesions in 4 cases were solitary. The tumors were located in the parietal lobe in 3 cases and in 1 case the lesions located in the frontal and temporal lobes. The round parencbymatous tumors were found in 2 cases and the tumors appeared as irregular lobulated shape in 2 cases. The cysticsolid lesions were found in 1 case and the solid lesions ap peared as mural nodules. The boundary of the tumors was unclear in 2 cases, while in other 2 cases the tumors were poorly cir cumscribed. The tumors were accompanied with heavy peritumoral brain edema and the neighboring brain tissue invasion can be seen in different degrees in all 4 cases,equ

关 键 词：脊索样脑膜瘤 临床病理 免疫组化 核磁共振成像 

分 类 号：R739.45[医药卫生—肿瘤]