非典型性脑膜瘤的临床病理学  

Atypical meningioma: a clinicopathologic study of 26 cases

作　　者：潘传敬[1] 刘宽宇 陈志远[1] 

机构地区：[1]成都军区总医院病理科,成都610083

出　　处：《临床与实验病理学杂志》2003年第6期583-586,共4页Chinese Journal of Clinical and Experimental Pathology

摘　　要：目的　探讨非典型性脑膜瘤 (AM )的病理组织学特点和诊断指标。方法　光镜观察 2 6例AM组织学改变、计数异型核、大核仁、核分裂和瘤巨细胞 ;图像分析胞核胞质面积比 ;免疫组化S P法标记Ki 6 7单克隆抗体 ,求标记指数 ;统计患者生存时间、肿瘤复发和长期生存率。同时以 35例良性脑膜瘤 (BM)和 13例恶性脑膜瘤 (MM )作对照。结果　 2 6例AM中梭形细胞为主 10例 ,上皮样细胞为主 14例 ,透明细胞型和囊性各 1例 ,占脑膜瘤总数的 16 4 5 %。 12例术后复发 ,2例复发后转为恶性 ,3例有脑组织微浸润。AM瘤细胞核质面积比为 2 9 84 % ,每 10个高倍视野大核仁数 2 5 5 4、异型核 2 7 0 3、瘤巨细胞5 4 1、核分裂象数 4 30 ,Ki 6 7标记指数是 10 15 % ,比BM高 ,较MM低 ,与两者相比差异都有显著性。标记指数和核分裂数呈正相关。AM复发率为 4 6 15 % ,生存时间 84 0 7个月 ,5年、10年生存率分别为 5 3 6 1%和 2 3 0 8% ,介于MM和BM之间 ,与两型差异均有显著性。结论　AM是复发率高、潜在恶性的交界性肿瘤。瘤组织不形成明显的漩涡状脑膜瘤结构 ,瘤细胞周界不清呈合体状 ;瘤细胞密集排列 ,核质比例增大 ;核中度异型性和多形性 ;有明显的大核仁 ;核分裂象≥ 4个 / 10HPF ;以上是诊断AM的必要指标。散在瘤巨细?Purpose To explore the histopathologic characteristics and diagnostic criteria in atypical meningioma(AM). Methods A total of 26 cases with AM were evaluated by light microscopy, S-P immunohistochemistry, image analysis and analysis of the followed up data. 35 cases of benign meningiomas (BM) and 13 cases of maligmant meningiomas (MM) were used as control. Results Of the 26 evaluable AM, 16.45% of the total meningiomas, histologically appeared predominently spindle cells and epithelioid cells were 10, 14 respectively, clear cell and cystic type had 1 each; 12 recurred, and 2 became MM. 3/26 had brain microinvasion. In the tumor cells of AM, nuclear/cytoplasmic area ratio was 29.84%, and macronucleoli, atypical nuclei,tumor gaint cell and mitoses were 255.4, 27.03, 5.41 and 4.30 (per 10 HPF) respectively; the labeling index of Ki-67 was 10.15%. The results exhibited higher than BM and lower than MM; the difference with BM and MM both had statistically significant. There was significant positive relation between the labeling index and the mitoses in AM. The AM was associated with 46.15% of recurrence, 84.07 months of the survival time, and 53.61% and 23.08% of 5, 10 years survival. Conclusions AM is a borderline tumor with high recurrence and malignant potential. The tumor tissues show no typical whorled structures of meningioma. The cytoplasmic membrance of the tumor cells indistinct as “syncytial”, hypercellularity high nuclear/cytoplasmic ratio, middling nuclear atypia and pleomorphism, prominent macronucleoli and mitoses ≥4/10 HPF are the essential criteria to diagnose AM; A few dispersive tumor gaint cells,focal necrosis and brain microinvasion also are the considerable criteria.

关 键 词：非典型性脑膜瘤 病理学 诊断指标 免疫组化 单克隆抗体 

分 类 号：R739.45[医药卫生—肿瘤]