胶质母细胞瘤115例临床病理分析

Clinicopatholigical analysis of 115 glioblastoma

目的 探讨胶质母细胞瘤临床病理特点、免疫表型、影像学特点、诊断及鉴别诊断。方法对115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。结果位于大脑半球的胶质母细胞瘤临床表现主要为头痛、呕吐、癫痫发作,肿瘤组织学显示瘤细胞弥漫分布,核异型性明显,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。免疫组化显示胶质纤维酸性蛋白(GFAP)和波形蛋白(vimentin)均呈强弱不等的阳性,Ki-67表达较高,阳性细胞数平均为34.3%,所有病例血管内皮细胞均表达CD34,P53的阳性率为25.2%。CT和MR检查示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。结论胶质母细胞组织形态具有一定的特征性;其影像学表现主要为水肿、出血、坏死和囊性变。

Objective To investigate the clinicopathologic features,immunophenotypes and image features in 115 cases of glioblastoma.Methods The clinical and pathological data of glioblastoma were collected and studied with H.E.and immunohistochemical staining.The image features of CT and MR were also analyzed.Results The clinical symptoms of the cases were headache,vomiting and epileptic seizure.Histopathologically,the tumor cells were distributed diffusely with marked nuclear atypia and brisk mitotic activity.Prominent microvascular proliferation and necrosis were useful features for the diagnosis.Tumor cells around the necrosis generally showed paliform arrangements.Immunohistochemical study demonstrated unequally positive staining for GFAP and vimentin.The average positive cell population of Ki-67 accounted for 34.3%.The endotheliocyte was positive for CD34.The expression rate of Ki-67 was 25.2%.The CT and MR scanning showed occupying lesions with hemorrhage,necrosis and cystic degeneration.The irregular circularity enhancement was showed after enhancement scanning.Conclusion The tumor origins from astrocyte and has marked pathological features.The malignant degree of glioblastoma is very high.Its image features are edema,hemorrhage,necrosis and cystic degeneration.The special types of glioblastoma need to distinguish from pleomorphic xanthoastrocytoma,malignant gangglioglioma,etc.