基于QST分型的颅咽管瘤与第三脑室底脑膜层次的关系  

Relationship between craniopharyngioma and the third ventricle floor meninges based on QST classification

作　　者：漆松涛[1] 刘忆[1] 汪潮湖[1] 樊俊[1] 潘军[1] 张喜安[1] 陆云涛[1] Qi Songtao;Liu Yi;Wang Chaohu;Fan Jun;Pan Jun;Zhang Xi′an;Lu Yuntao(Department of Neurosurgery,Nanfang Hospital of Southern Medical University,Guangzhou 510515,China)

机构地区：[1]南方医科大学南方医院神经外科,广州510515

出　　处：《中华神经外科杂志》2020年第3期232-237,共6页Chinese Journal of Neurosurgery

基　　金：广东省科技计划项目(2016A020213006,2017A020215048,2017A020215191);广东省自然科学基金(2016A030310377);广州市科技计划项目(201707010149);南方医科大学南方医院院长基金(2015C018,2016L002,2016B006,2017Z009)。

摘　　要：目的探索基于QST分型的、累及第三脑室底的颅咽管瘤与第三脑室底脑膜层次的关系及临床意义。方法回顾性分析2018年1月至2019年10月南方医科大学南方医院神经外科在神经内镜下行肿瘤全切除术治疗累及第三脑室底的原发性颅咽管瘤患者的临床资料(共17例,其中Q型6例,S型3例,T型8例),所有患者术中均留取肿瘤组织标本。正常鞍区标本来源于同期该院行人工引产或自然流产的胎儿(8例)。对以上标本进行苏木素-伊红(HE)和免疫荧光双标染色,应用波形蛋白抗体标记硬脑膜,Ⅰ型胶原蛋白抗体标记蛛网膜,胶质纤维酸性蛋白抗体和层粘连蛋白抗体标记软脑膜,以CK18抗体标记腺垂体,以CK5/6抗体标记颅咽管瘤。观察胎儿脑组织标本的脑膜染色情况以及不同QST分型的颅咽管瘤组织与第三脑室底脑膜的层次关系。结果8例胎儿标本均成功标记硬脑膜、蛛网膜、软脑膜。颅咽管瘤标本HE染色及免疫荧光双标染色结果显示,所有Q型肿瘤(6/6)与第三脑室底之间存在硬脑膜(鞍膈);所有S型肿瘤(3/3)与第三脑室底之间存在蛛网膜和软脑膜;T型肿瘤与第三脑室底之间存在3种病理学形态关系,分别命名为卯榫样、地幔样及护城河样关系,所有T型肿瘤(8/8)与第三脑室底之间有软脑膜分隔,但在肿瘤起源点处,软脑膜可逐渐消失。当肿瘤极度挤压第三脑室空间时,第三脑室室管膜仍可保持完整。结论不同QST分型的颅咽管瘤均可累及第三脑室底,且与第三脑室底之间存在不同的脑膜层次;这些脑膜层次是手术安全切除累及第三脑室底的颅咽管瘤的天然屏障。Objective To explore the relationship between craniopharyngioma based on QST classification with invovlement of the third ventricle floor and the third ventricle floor meninges and its clinical significance.Methods The clinical data of 17 primary craniopharyngioma patients with involvement of the third ventricle floor(6 cases of Q type,3 cases of S type and 8 cases of T type)undergoing total tumor resection under neuroendoscopy from January 2018 to October 2019 at Neurosurgery Department of Nanfang Hospital,Southern Medical University were retrospectively analyzed.Tumor tissue samples were taken from all patients during operation.The specimens of the normal sellar region were derived from the fetus(8 cases)of the artificial or spontaneous abortion at Nanfang Hospital of Southern Medical University during the same period.Samples were stained by hematoxylin eosin(HE)and immunofluorescence double staining.The dura was labelled with vimentin antibody,arachnoid with type I collagen antibody,pia with glial fibrillary acidic protein antibody and laminin antibody,adenohypophysis with CK18 antibody and craniopharyngioma with CK5/6 antibody.We then observed the meningeal staining of fetal brain tissue and relationship between different QST types of craniopharyngioma tissue and the third ventricle floor meninges.Results The dura mater,arachnoid and pia mater of 8 fetuses were labelled successfully.HE staining and immunofluorescence double staining of craniopharyngioma showed that in type Q tumor(6/6),there were dura mater(diaphragma sellae)between tumor and the third ventricle floor.In type S tumor(3/3),there were arachnoid membrane and pia mater between tumor and the third ventricle floor.There were 3 patterns regarding the relationship between type T tumor and the third ventricle floor:mantle-like relationship,moat-like and mortise-like types.There was pia mater between type T tumor(8/8)and the third ventricle floor,and the pia mater could gradually disappear at the origin point of tumor.Although the tumor could remarkabl

关 键 词：颅咽管瘤 第三脑室 蝶鞍 脑膜 病理学 

分 类 号：R73[医药卫生—肿瘤]