分泌型脑膜瘤13例临床病理分析

Secretory meningioma: a clinicopathological study of 13 cases

目的 探讨分泌型脑膜瘤的临床病理学特征.方法 对13例颅内分泌型脑膜瘤病例的临床表现、影像学、病理学、免疫组化及组织化学特征进行回顾性分析,并复习相关文献.结果 13例分泌型脑膜瘤患者均为女性,年龄43 ～ 66岁,平均53.9岁.其中10例肿瘤镜下为脑膜上皮型脑膜瘤背景,并有2例伴发脂肪化生;2例为过渡型脑膜瘤背景;1例为微囊型脑膜瘤背景.肿瘤主要特征为灶性上皮细胞分化伴微腺腔样结构形成并内含嗜伊红分泌物质.免疫组化示嗜酸性分泌物CEA和EMA（＋）;组织化学示PAS和六胺银（＋）.随访2～66个月,均未发现肿瘤复发和转移.结论 分泌型脑膜瘤是发生于颅内的少见肿瘤,中老年女性好发,预后良好.嗜酸性分泌小体的出现是该肿瘤的重要诊断依据;除了PAS,六胺银染色也可以作为诊断分泌型脑膜瘤的重要组织化学方法.

Objective To study the clinicopathological features of secretory meningioma. Methods The clinical manifestations, radiological, histopathological, histochemical and immunohistochemical features were retrospectively analysed in 13 cases of intracranial secretory meningioma and related literatures were reviewed. Results All of 13 patients with secretory meningiomas were females. The age ranged from 43 to 66 years, with mean age of 53.9 years. Microscopically, 10 cases developed within a backgroud of meningothelial meningioma with lipomatous component in 2 case, 2 case within a transitional meningioma, and 1 case within a microcystic meningioma. There was advanced epithelial differentiation in the form of gland-like structures with eosinophilic secretions, both within intracellular lumina and between flattened neoplastic cells. These eosinophilic secretions were positive for CEA and EMA immunostaining, and for PAS and hexamine-silver staining. No recurrence or metastases ~as confirmed during follow-up from 2 to 66 months. Conclusion Secretory meningioma is a rare intracranial tumor with a female predominance and good prognosis. Presence of eosinophilic secretion is the key diagnostic feature. Besides PAS, hexamine-silver staining may be an important method for diagnosis of secretory meningioma.