颅内浆细胞肿瘤的临床病理分析(21例报告)

Clinicopathologic study of intracranial plasmacytoma

目的探讨颅内浆细胞肿瘤的病理分型与临床特征。方法应用光镜,免疫组织化学EnVision法染色,并结合临床资料、血液学检查和辅助检查资料,对21例颅内浆细胞肿瘤进行观察分析。结果颅内浆细胞肿瘤包括3个亚型:浆细胞骨髓瘤、骨内孤立性浆细胞瘤和骨外浆细胞瘤。发病中位年龄58岁,无性别差异。病理示肿瘤细胞含丰富的嗜酸性胞浆,核偏位。分化差的可显示细胞异型,病理性核分裂象、或坏死等现象。免疫组化:单链限制性表达,K轻链阳性占12/21,19/21病例CD138阳性,11/21病例CD79α阳性,12/21病例LCA阳性,Ki-67≤1%占9/21。本组中浆细胞骨髓瘤5例,其中3例分别随访6年、3年和2年,未复发。骨内孤立性浆细胞瘤15例,其中1例患者随访3年,病情稳定。骨外浆细胞瘤1例,随访1年未复发。结论颅内浆细胞肿瘤以骨内孤立性浆细胞瘤亚型多见,各亚型间病理形态和免疫表型相似,但临床治疗策略和预后有差别,所以应明确诊断病理分型,针对性治疗,长期随访。

Objective To study the pathological features of intracranial plasmacytoma typing and their relationship with clinical presentations.Methods The clinical and histopathological findings were retrospectively analyzed 21 intracranial plasmacytoma cases.Immunohistochemical（EnVision） study was performed.Results There were three types of intracranial plasmacytoma in our cases including 15 cases of solitary plasmacytoma of bone,5 cases of myeloma and one cases of extra-osseous plasmacytoma.The median age of patients was 58 years and gender was not significantly different among three types.The microscopical findings showed that the tumor cells contained eccentric round nuclei,and coarse chromatin and that the immature plasma cells exhibited the nuclear pleiomorphism,mitosis and necrosis.Immunostaining revealed that all lesions were Single-chain antigen binding positive.Among them,12/21cases showed positive for K light chains,19/21 cases showed CD138 positive,11/21cases showed CD79α positive,12/21 cases showed LCA positive and 9/21 showed Ki-67≤1%.The diagnosis was confirmed by the combination of the pathological and hematological findings.3 cases of myeloma were followed up for 2,3,and 6 years,respectively and did not recur;One case of solitary plasmacytoma of bone was followed up for one year and did not recur and one case extra-osseous plasmacytoma was Followed up for one year and did no recur.Conclusions The solitary plasmacytoma of bone is common among the intracranial plasmacytoma.Although the histological and immunophenotype are similar among different intracranial plasmacytoma,the treatment and prognosis are different for those three types of intracranial plasmacytoma.A cautious follow up would be recommended to exclude recurrence of tumor.