脑膜瘤的超微结构特点及其临床意义

Ultrastructural characteristics of meningioma and its clinical significance

目的:探讨颅内脑膜瘤超微结构特点及其与疾病预后的关系。方法:采用光镜、免疫组化、电镜方法对肿瘤组织进行检测。结果:脑膜瘤共165例,复发35例,复发率为21.1%。组织病理学类型包括脑膜内皮型73例,过渡型13例,纤维型35例,血管瘤型13例,移行型27例,非典型脑膜瘤2例,间变型脑膜瘤2例。免疫组织化学标志物EMA,PR,Vimentin,Ki67,CD34均有不同程度表达,GFAP,S-100,desmin,c-erbB-2均阴性表达。透射电镜观察发现瘤细胞多密集分布,胞质表面可见丰富膜性突起,突起长短不一。其中内皮型脑膜瘤瘤细胞间胞膜呈指状交错,可见桥粒连接。纤维型及过渡型细胞梭形,细胞外有大量胶原纤维。血管瘤型血管内皮细胞间有较大空隙,血管基膜不完整。移行型由上述细胞成分混合而成。非典型细胞核呈不规则锯齿状,指状突起发育不良,桥粒细而少。间变型细胞核异形明显,交指状突起萎缩,形状极不规则,桥粒和胶原纤维丝变少。结论:脑膜瘤细胞超微结构观察可对组织病理学、免疫组化结果进行有益补充,为脑膜瘤的临床诊断、治疗以及预后判断提供有用依据。

Objective:To investigate the ultrastructural characteristics of intracranial meningioma and its relationship with the prognosis of the disease.Methods:The tumor tissue was detected by light microscopy,immunohistochemistry and electron microscopy.Results:In 165 cases of meningiomas,35 cases recurred,and the recurrence rate was 21%.The histopathological types included 73 cases of meningeal endothelial type,13 cases of transitional type,35 cases of fibrous type,13 cases of hemangioma type,28 cases of transitional type,2 cases of malignant meningioma and 1 case of meningeal melanoma.Immunohistochemical markers EMA,PR,vimentin,Ki67,CD34 were expressed in varying degrees,and GFAP,S-100,desmin,C-erbB-2 were negative.Transmission electron microscopy showed that the tumor cells were densely distributed,there were abundant membrane processes on the surface of the cytoplasm,and the processes were different in length.The intercellular membrane of endothelial type is interdigitated,and desmosomes is connected.The cells of fibrous type and transitional type are fusiform,and there are a lot of collagen fibers outside the cells.There is a large gap between the endothelial cells of hemangioma type,and the vascular basement membrane is incomplete.The transitional type is composed of the above cell components.The nuclei of atypical type are irregularly serrated,the finger processes are poorly developed,and the desmosomes are thin and few.The nuclear heteromorphia of anaplastic type is obvious,the interdigital processes are atrophic,the shape is very irregular,and the desmosomes and collagen filaments are less.Conclusion:The ultrastructural observation of meningioma cells can be helpful to give a supplement to the histopathology and immunohistochemistry,and it also provides useful basis for the clinical diagnosis,treatment and prognosis of meningioma.