颅内胶质母细胞瘤51例临床病理分析

Intracranial glioblastoma:a clinicopathologic analysis of 51 cases

目的回顾性分析51例胶质母细胞瘤临床病理特征、免疫表型、影像学特点、诊断及鉴别诊断。方法对51例胶质母细胞瘤标本进行临床资料统计,应用HE染色、免疫组化等方法进行病理学特征观察,CT和MR检查分析其影像特点。结果胶质母细胞瘤临床表现主要为头晕、头痛、呕吐,CT和MR检查示颅内界限不清的占位性病变,常伴有出血、坏死和囊性变,增强扫描呈不规则环状强化。肿瘤组织学显示瘤细胞弥漫分布,异型性明显,血管明显增生,伴有出血和坏死,坏死灶周围瘤细胞常排列呈栅栏状。免疫组化显示GFAP和vimentin均呈强弱不等的阳性,Ki-67表达较高,阳性细胞数平均为28.94%,而其它标记物的表达不尽相同。结论胶质母细胞瘤来源于星形细胞,组织形态具有一定的特征性,在颅内肿瘤中恶性程度最高,预后差。其影像学表现与肿瘤的病理改变密切相关。特殊类型的胶质母细胞瘤须注意与胶质肉瘤、恶性神经节细胞胶质瘤等相鉴别。

Purpose To analyze the clinicopathologic features, immunophenotypes and image features in 51 cases of intracranial glioblastoma. Methods The clinical and pathological data of the iutracranial glioblastoma were collected and studied with H.E. and immunohistochemical staining. The image features of CT and MR were also analyzed in those cases. Results The clinical symptoms of these cases were dizziness, headache and vomiting. The CT and MR scanning showed intracranial occupying lesions with hemorrhage, necrosis and cystic degeneration. The irregular circularity enhancement was showed after enhancement scanning. Histopathologieally, the tumor cells were distributed diffusely with marked nuclear atypia and brisk mitotic activity. Prominent mierovascular proliferation and necrosis were useful features for the diagnosis. Tumor cells around the necrosis generally showed paliform arrangements. Immunohistoehemical study demonstrated unequally positive staining for GFAP and vimentin. The average positive cell population of Ki-67 accounted for 28. 94%. The expression rates of other tumor markers were different. Conclusions This tumor origins from astrocyte and has marked pathological features. The malignant degree of glioblastoma is very high with poor prognosis. Its image features are closely correlated with its pathological features. The special types of gliohlastoma need to distinguish from gliosarcoma, malignant gangglioglioma and others.