分泌型脑膜瘤的临床和病理特点

Analysis of Clinical and Pathological Features of Secretory Meningiomas

目的探讨分泌型脑膜瘤的临床病理和免疫表型特点。方法对9例分泌型脑膜瘤分别进行HE、过碘酸-希夫（PAS）和PAS酶消化后（PAS—D）染色；用免疫组织化学SP法检测ER、PR、CEA、CK、EMA和MIB-1等标记；1例肿瘤进行电镜观察。结果9例分泌型脑膜瘤分别位于碟骨嵴、左顶部或额部；5例有明显的肿瘤周围水肿；9例中7例随访时间6～88月，未见复发；组织学特点：细胞质内或细胞间均可见大小不等的透明包涵体，血管周细胞增生；9例包涵体PAS染色及PAS—D染色均呈阳性；免疫表型检测显示9例肿瘤细胞PR阳性，8例ER阴性，7例包涵体和周围细胞CEA、CK、EMA阳性。1例MIB-1阳性率为5％，余8例MIB阳性率不超过2％。电镜观察见细胞间腔隙形成及含有粘液的细胞。结论分泌型脑膜瘤是一种少见的颅内脑膜瘤亚型，显示腺上皮分化，复发率低，预后较好。

Objective To investigate the clinicopathologic and immunohistochemical features of secretory meningiomas. Methods Nine secretory meningiomas were examined. From each specimen, sections were cut and stained with hematoxylin-eosin, periodic acid-Schiff （PAS） stain, and periodic acid-sehiff stain with diatase （PASD ）. Immunohistochemical markers including oestrogen receptor （ER）, progesterone receptor （ PR ）, carcinoembryonic antigen （CEA）, cytokeratin （CK）, epithelial membrane antigen （EMA）, and MIB-1 were detected with streptavidin peroxidase （SP） immunohistochemical staining methods. One case was observed by electron microscopy （EM）. Results The 9 secretory meningiomas were located at sphenoid ridge, left parietal lobe or frontal lobe. Severe peritumoral edema was observed in 5 cases. Seven cases were followed up for 6 to 88 months; none of them showed evidence of recurrence. Histologically, the conspicuous feature was the eosinophilic inclusions. The finding of pericytic proliferation on examination was helpful to making a diagnosis. In all 9 cases, the tumor cells were positive for PR, but in 6 cases the inclusions were negative. ER was negative in 8 cases. CEA,CK, EMA expressed in the inclusions and the surrounding cells in 7 cases. In 1 case the positive rate for MIB-1 was 5%, but in the other 8 cases the positive rates were not more than 2%. The intercellular lumens and intracellular mucosa were observed under EM. Conclusion Secretory meningioma is a rare subtype of meningioma that shows glandular epithelium differentiation. It is a meningioma of the low-risk type in terms of incidence, recurrence and prognosis.