西藏地区脑膜瘤临床病理观察  

Clinicopathological Features of Meningiomas in Tibet

作　　者：罗含欢[1] 霍真[2] 王倩 尼玛卓玛 多布啦 魏倩[1] 达珍[1] 王寒 郭平平 廖瑞倩 次仁曲珍 LUO Hanhuan;HUO Zhen;WANG Qian;NImazhuoma;DUObula;WEI Qian;DA Zhen;WANG Han;GUO Pingping;LIAO Ruiqian;CIrenquzhen(Department of Pathology,Tibet Autonomous Region People’s Hospital,Lhasa 850000,China;Department of Pathology,PUMC Hospital,CAMS and PUMC,Beijing 100730,China)

机构地区：[1]西藏自治区人民医院病理科,拉萨850000 [2]中国医学科学院北京协和医学院北京协和医院病理科,北京100730

出　　处：《中国医学科学院学报》2022年第4期621-627,共7页Acta Academiae Medicinae Sinicae

基　　金：中国医学科学院中央级公益性科研院所基本科研业务费专项资金(2020-RW320-002)。

摘　　要：目的 探讨西藏地区藏族人群脑膜瘤的临床病理特征和免疫组织化学的表达情况,旨在提高对脑膜瘤的认识。方法 回顾性分析西藏自治区人民医院2013年4月至2021年3月病理存档的116例脑膜瘤患者的临床和病理资料,全部病例均进行组蛋白H3第27位赖氨酸的三甲基化修饰(H3K27me3)、黏蛋白4(MUC4)、生长抑素受体2(SSTR2)、孕激素受体、上皮细胞膜抗原、胶质纤维酸性蛋白、波形蛋白、S-100、P53、Ki-67免疫组织化学染色,显微镜下进行病理形态学观察和染色结果评估。结果 共116例脑膜瘤患者,男∶女比例为1.0∶2.6,年龄4~73岁;临床症状主要表现为头痛。影像学检查显示114例为单发病灶、2例为多发病灶;108例位于颅内、8例位于椎管;肿瘤最大径0.3~10.0 cm,平均(5.7±2.2) cm。显微镜下分级和组织学类型方面:111例为WHOⅠ级,其中纤维型(53例)、脑膜上皮细胞型(20例)、过渡型(24例)和砂砾体型(10例)多见;4例为WHOⅡ级(3例为非典型脑膜瘤、1例为透明细胞型);1例为WHOⅢ级(乳头型)。免疫组织化学方面:9例(9/116,7.8%)H3K27me3表达缺失,64例(64/116,55.2%)MUC4阳性,101例(101/116,87.1%)SSTR2阳性。80例有随访结果,71例无复发、9例复发。结论 脑膜瘤是西藏地区病理存档资料中最常见的中枢神经系统肿瘤,以中年女性患者多见,颅内上矢状窦旁、大脑镰旁和大脑凸面占位为主。WHOⅠ级的纤维型脑膜瘤最多见,WHOⅡ和Ⅲ级的脑膜瘤少见。MUC4在脑膜上皮细胞型和过渡型脑膜瘤中表达率较高,在纤维型中表达率偏低;H3K27me3表达缺失可能与预后无相关性。Objective To analyze the clinicopathological features and immunohistochemical expression of meningiomas in the Tibetan population in Tibet, and improve the understanding of meningiomas.Methods The clinical and pathological data of all the meningiomas diagnosed by pathology in Tibet Autonomous Region People’s Hospital from April 2013 to March 2021 were analyzed retrospectively.All the cases underwent immunohistochemical staining of trimethylation of lysine 27 on histone H3(H3 K27 me3),mucin 4(MUC4),somatostatin receptor 2(SSTR2),progesterone receptor, epithelial membrane antigen, glial fibrillary acidic protein, vimentin, S-100,P53,and Ki-67.The histopathological features and the staining results were observed under a light microscope.Results A total of 116 cases of meningiomas were included in this study, with the male-to-female ratio of 1.0∶2.6 and the age of 4-73 years.The main clinical symptom was headache.The imaging examination showed that 114 cases had single lesions and 2 cases had multiple lesions.The tumors were located in the cranium(108 cases) and spinal canal(8 cases).The maximum diameter of the tumors ranged from 0.3 cm to 10.0 cm, with a mean of(5.7±2.2) cm.In terms of microscopic grading and histological types, the 116 cases included 111 cases of WHO grade Ⅰ(including 53 cases of fibrous type, 20 cases of meningothelial type, 24 cases of transitional type, 10 cases of psammomatous type, etc.),4 cases of WHO grade Ⅱ(3 cases of atypical type and 1 case of clear cell type),and 1 case of WHO grade Ⅲ(papillary type).The immunohistochemical staining showed H3 K27 me3 expression absent in 9 cases(9/116,7.8%),MUC4 positive in 64 cases(64/116,55.2%),SSTR2 positive in 101 cases(101/116,87.1%).Eighty cases had follow-up results, among which 71 cases had no recurrence, while 9 cases recurred.Conclusions Meningioma is the most common tumor in the central nervous system in the pathological file of Tibet.It mainly attacks the middle-aged female patients, occupying the parasagittal sinus, falx, and conv

关 键 词：西藏地区 藏族人群 脑膜瘤 病理特征 免疫组织化学 组蛋白H3第27位赖氨酸的三甲基化修饰 黏蛋白4 

分 类 号：R739.45[医药卫生—肿瘤]