乳头状瘤型脑膜瘤

Papillary meningioma

目的探讨乳头状瘤型脑膜瘤的临床病理学特征。方法对1例乳头状瘤型脑膜瘤患者的临床表现、影像学、组织形态学及免疫组织化学染色结果进行分析,并复习相关文献。结果女性患者,43岁。MRI检查显示左侧额颞部软组织肿块影,其内信号不均匀,可见低信号囊变区;增强扫描呈明显强化。组织病理学检查可见在广泛坏死和出血背景下,肿瘤组织围绕血管呈单层或复层排列,形成乳头状结构,肿瘤细胞异型性明显,胞质丰富、淡染,胞核呈圆形或卵圆形,核膜增厚呈空泡状,染色质呈粗颗粒,核分裂象易见,无明显核仁。免疫组织化学染色波形蛋白表达阳性;S-100蛋白、上皮膜抗原、广谱细胞角蛋白、绒毛膜促性腺激素、胎盘碱性磷酸酶、胶质纤维酸性蛋白、内皮细胞标志物CD31及结蛋白表达阴性;Ki-67抗原标记指数为3.13%。结论乳头状瘤品脑膜瘤临床罕见,影像学表现有一定的诊断提示意义,明确诊断依赖于特征性的形态学特点和免疫学表型。

Objective To investigate the clinicopathological features of papillary meningioma. Methods The clinical manifestations, imaging, histopathological features and immunophenotype were analysed in one case of papillary meningioma, with review of related literatures. Results The patient was a 43 year-old woman. Magnetic resonance imaging （MRI） examination revealed a parenchyma mass at left frontotemporal with asymmetrical signal, low signal of cystoid area with distinct enhance. Histologically, the presence of a perivascular pseudopapillary pattern comprised the majority of the tumor on the background of necrosis and hemorrhage. The other area consisted of dispersed cells and some lobules. Most tumor cells were atypical and anaplasia, obvious malignant cytology resembling carcinoma, melanoma or high grade sarcoma. Abundant mitotic figures were present. In the same case, tumor cells appeared to form a whorl in the lobules with oval nuclei with delicate chromatin. Immunohistochemical analysis showed intense immunoreactivity of the ceils to vimentin （Veto） antigens. The cells showed a negative reaction for S-100 protein （S- 100）, epithelial membrane antigen （EMA）, keratin, human chorionic gonadotropin （hCG）, placental alkaline phosphatase （PLAP）, glial fibrillary acidic protein （GFAP）, CD31 and desmin （Des）. The Ki-67 positive rate was 3.13%. Conclusion Papillary meningioma is a rare tumor. The image features can offer certain diagnostic cues. The diagnosis may be made on histological and immunohistochemical features.