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非典型腦膜瘤9例臨床病理特徵與預後分析
Atypical meningioma: clinicopathologic features and prognostic analysis of 9 cases
摘要
目的：探討非典型腦膜瘤（atypical meningioma, AM）的臨床病理學特點和復發率。方法：回顧性分析9例非典型腦膜瘤患者的臨床資料、影像學、病理鏡下形態特點和免疫組織化學染色特點，並隨訪患者的復發率和預後情況。結果：9例中男性4例，女性5例，發病年齡3歲～69歲。多發生於額部大腦鐮旁，以頭痛、肢體功能障礙為主要臨床症狀。組織學表現為核分裂增多≥4/10HPF有7例、細胞密度高9例、小細胞伴核漿比升高4例、細胞可見明顯核仁8例、無定型片狀生長9例、壞死6例及浸潤周圍腦組織6例。免疫組織化學染色：腫瘤細胞9例均EMA陽性及Vimentin陽性、GFAP陰性。Ki-67增殖指數平均為5%。9例中6例PR陽性。全部病例隨訪結果，2例復發（22%）。結論：非典型腦膜瘤是一種高復發性的腦腫瘤，復發可能與周圍腦組織浸潤相關。
並列摘要
Objective: To investigate the clinicopathological features and recurrence rate of atypical meningioma (AM) after operative removal. Methods: The clinicopathologic data, MRI, morphological features and immune-histochemical characteristics were reviewed in 9 cases of AM. The survival and recurrence were assessed during followed-up visits. Results: Among the 9 cases of AM, there were 4 males and 5 females. The age ranged from 3~69 years old. The tumor most commonly occurred in frontal lobe attached to falx cerebri. Main symptoms were headache and physical dysfunction. Microscopically, increased mitotic activity (>4 mitoses per 10 high powered fields)was observed in 7 cases, increased cellularity in all 9 cases, small cells with a high nuclear to cytoplasmic ratio in 4 cases and prominent nucleoli in 8 cases. All 9 cases of tumors grew in uninterrupted pattern lessor sheet-like pattern, with 6 cases showing focal necrosis and brain-invasion. Immunohistochemically,the tumor cells of all cases were positive for EMA, Vimentin, and negative for GFAP. PR was positive in6 cases. The mean Ki-67 proliferation index was 5%. All cases were followed up for 2 to 54 months, Two cases (22%) recurred after operation. Conclusion: AM as meningioma has high recurrence rate. The recurrence was likely related to brain-invasion.