幕上脑实质室管膜瘤临床和病理分析

Clinicopathological analysis of supratentorial parenchymal ependymomas

目的：探讨幕上脑实质室管膜瘤的临床和病理特点以及免疫表型。方法对12例幕上室管膜瘤患者的临床和病理资料进行分析，并进行免疫组化染色。结果患者平均年龄29岁，病变多数发生在额叶和顶叶，临床症状主要为颅内压增高表现，包括头痛、头晕、恶心和呕吐等。组织学显示幕上室管膜瘤和幕下室管膜瘤的结构较一致，肿瘤细胞呈椭圆形或梭形，弥漫性或片状分布，体积偏小，核较大染色深，呈真、假菊型团排列。免疫组化胶质纤维酸性蛋白（GFAP）、波形蛋白（vimentin）和 S-100蛋白（S-100）大多数阳性（＋），上皮膜抗原（EMA）部分阳性（＋）、神经细胞黏附分子（CD56）和神经元特异性烯醇化酶（NSE）少数阳性（＋）。结论幕上脑实质室管膜瘤可发生在幕上的任何部位，以额、顶叶多见，具有特定的病理形态学表现及免疫表型，临床无特征性症状，易误诊，确诊依靠病理学检查。手术切除彻底与否与预后关系较大。

Objective To study the clinicopathological characteristics and the immunohistochemistry of supratentorial parenchymal ependymoma.Methods The clinical and pathological data of 12 patients with supratento-rial parenchymal ependymoma were analyzed,and the tissue slices were immunohistochemically stained.Results The average age of the patients was 29 years old.Most of the lesions occurred in the frontal and parietal lobes,with increased intracranial pressure as the main clinical symptom,including headache,dizziness,nausea and vomiting.The histology showed that the structure of supratentorial parenchymal ependymoma was consistent with that of infratentorial ependymoma.The tumor cells were oval or spindle shaped,diffuse or patchy distribution,small volume,large nuclear staining deep,and were arranged in Flexner-Winterseiner or Homer-Wright.The immunohistochemistry showed that GFAP,vimentin and S-100 were mostly positive,EMA was partly positive and CD56 and NSE were rarely positive. Conclusion Supratentorial parenchymal ependymoma can occur in any part of the supratentorium,mostly in the fron-tal and parietal lobes.It has a specific pathological morphology and immune phenotype,without any characteristic symptoms in clinical,which is easy to be misdiagnosed.Its diagnosis depends on the pathological examination and the prognosis is largely related to whether the surgical resection is complete or not.