脑肿瘤放射性治疗后迟发型脑损伤的临床病理学特征

Cliulcopathologic features of delayed radiation-induced brain injury after radiotherapy for brain tumor

目的探讨脑肿瘤放射性治疗后迟发型放射性脑损伤的临床病理特征。方法对9例行肿瘤术后放射性治疗的迟发型脑损伤手术治疗病例的临床资料、组织病理学以及免疫组织化学染色进行分析。结果9例迟发型放射性脑损伤患者发病时长6个月至12年，临床主要表现为头痛及肌力减退。MRI表现为轻微占位效应的病变，边缘强化及周围水肿。组织学主要特征为凝固性坏死，坏死中央血管纤维素样坏死、玻璃样变及管腔阻塞，周围反应性胶质细胞增生等。免疫组织化学显示增生的胶质细胞缺氧诱导因子-1α阳性表达。结论放射性治疗后迟发型脑损伤是肿瘤放射性治疗后的非肿瘤性继发性病变，常被误诊为脑肿瘤而行外科手术治疗，组织形态学有时可与高级别胶质肿瘤混淆，正确诊断需结合临床放射病史、影像学资料以及病理学特征等。

Objective To study the clinicopathologic features of delayed radiation-induced brain injury after radiotherapy for brain tumor. Methods The clinical, histopathologic and immunohistochemical features of 9 cases with delayed radiation-induced injury were evaluated. Results The disease occurred from 6 months to 12 years after radiotherapy and often presented with headache and muscle weakness. Magnetic resonance imaging showed peripheral enhancing lesions with slight mass effect and surrounding edema. Microscopically, the major changes included coagulative necrosis, fibrinoid necrosis of vessels, vascular hyalinization with luminal stenosis and peripheral reactive gliosis. Immunostaining for hypoxia- inducible factors lot was positive in reactive astrocytes. Conclusions Delayed radiation-induced brain injury is a relatively common complication of radiation therapy. The lesion was frequently misdiagnosed as brain tumor. Correct diagnosis relies on clinical, radiologic and pathologic correlation.