特殊类型脑膜瘤和脑膜的血管外皮瘤的临床病理

Clinico-pathological changes of some special variants or meningtomas and meningeal hemangiopericytomas

收集少见的特殊类型脑膜瘤，包括微囊型４例，富于淋巴浆细胞型２例，脊索样型２例，透明细胞型１例，分泌型１例，乳头型２例，间变型２例；另脑膜的血管外皮瘤５例，共１９例。除ＨＥ染色外，并做５种免疫组化染色（ｖｉｍｅｎｔｉｎ、ＥＭＡ、ｋｅｒａｔｉｎ、ＦⅧ、ＧＦＡＰ）及ＡＢ－ＰＡＳ染色，５例还做了常规电镜检查。另用１１例常见类型脑膜瘤做同样染色进行对照。通过研究总结出各型脑膜瘤的形态特征，结合临床、形态和免疫组化等结果，讨论了各型肿瘤的发生机制。提出过去诊断血管母细胞性脑膜瘤大多实为脑膜的血管外皮瘤，其免疫组化和电镜特征不同于脑膜瘤而与外周性血管外皮瘤相同，是一种位于ＣＮＳ的血管外皮瘤，而不再认为是脑膜瘤的亚型。

Fourteen cases of rare special variants of meningiomas were collected, including 4 cases of microcystic type, 2 of lymphoplasmacyte-rich type, 2 of chordoid type, one of clear cell type, one of secretory type, 2 of papillary type and 2 of anaplastic (malignant) type, and other 5 of meningeal hemangiopericytomas. A panel of antibodies of vimentin, epithelial membrane antigen, keratin, factor VIII-related antigen and glial fibrillary acidic protein,and AB-PAS staining were used. The morphological features in each subtype of meningioma were summarized in the study and the histogenesis of each subtype was discussed in combination with the clinical, morphological and immunohistochemical results. It was suggested that most of the so-called angioblastic meningiomas diagnosed in the past might actually be meningeal hemangiopericytomas, different in immunohistochemical and ultrastructural appearance from meningioma but similar to peripheral hemangiopericytomas, and should be considered as hemangiopericytomas in the central nervous system rather than a subtype of meningioma.