胶质母细胞瘤病理取材方式-七分法取材

Molecular and histopathological differences depending on different MRI findings and tumor location in Glioblastoma

目的规范胶质母细胞瘤(GBM)的病理取材方式,为临床提供更为准确的病理信息。方法我们规范GBM病理取材方式为"七分法取材",即由术者在术中对GBM瘤块的"中心、前方、后方、内测、外侧、上方、下方"共7个位置进行取材。本研究共纳入了40例经"七分法取材"的GBM患者,我们分别对各个位置取材的肿瘤组织进行原代细胞培养,免疫组化检测7个位置取材组织的IDH1蛋白、MGMT蛋白的表达情况。结果肿瘤中心取材的肿瘤组织100%培养出了肿瘤细胞,细胞呈长梭形、迁移快、增殖较块;T1增强像以外其他位置取材的肿瘤组织原代细胞培养成功率为60%,细胞呈圆钝形、迁移慢、增殖慢,两种细胞在细胞形态、细胞学功能上存在明显差异。IDH1蛋白在7个位置表达情况存在差异的病例为10例,比例为25%,差异具有统计学意义(P=0.001);MGMT蛋白在7个位置表达存在差异的病例为12例,占比为30%,差异具有统计学意义(P=0.004)。结论 7个位置取材的组织中均可培养出肿瘤细胞,并且IDH1及MGMT蛋白的表达也存在差异。中心取材的肿瘤组织虽能准确反映肿瘤的病理学级别,但是考虑到GBM高度异质性故需综合考虑其他位置取材的组织病理及分子病理特征,才能更准确地反应肿瘤的生物学特性。故七分法取材较传统的病理取材对GBM的病理诊断更有指导意义。

Objective To normalize the pathological sampling and provide precise information for clinical doctors. Methods We normalized Seven-part sampling method as the standard method of pathological sampling.Seven samples from seven different directions of Glioblastoma （GBM） tumor （central anterior, posterior, medial lateral superior, inferior） were obtained by neurosurgeon during surgery. Forty glioblastoma patients which had pathological samples through Seven-part Sampling Method were included. Primary tumor cells cultivation were conducted. The expressions of MGMT, IDH1 proteins were detected through IHC in these seven tumor samples. Results Tumor cells were cultivated in 100% from tumor tissue which in center of GBM tumor successfully.The primary tumor cells were spindle-shape with a strong ability of migration and high rate of proliferation. Primary tumor cells were cultivated in other sites of GBM tumor with a successful rate of 60%. The cells were obtuse-shape with a slower ability of migration and rate of proliferation. The two kinds of primary cells were different of cell morphology and biology. The expressions of IDH1 protein IHC in 10 cases were significantly different （P=0.001）. The expressions of MGMT protein in 12 cases were significantly different （P--0.004）. Conclusion Seven sites in GBM tumor have tumor cells. The expressions of IDH1 and MGMT proteins are different. The tumor tissue obtained from central site of GBM tumor can reflect the pathological grade of tumor more accurately.The other 6 sites in peritumoral area can reflect the molecular pathology information of these residual tumor cells which carunot be removed by surgery. Seven-part sampling method is very important for pathological diagnosis of glioblastoma.