非典型腦膜瘤9例臨床病理特徵與預後分析

Atypical meningioma:clinicopathologic features and prognostic analysis of 9 cases

目的探討非典型腦膜瘤(atypical meningioma,AM)的臨床病理學特點和復發率。方法回顧性分析9例非典型腦膜瘤患者的臨床資料、影像學、病理鏡下形態特點和免疫組織化學染色特點,並隨訪患者的復發率和預後情況。結果9例中男性4例,女性5例,發病年齡3歲~69歲。多發生於額部大腦鐮旁,以頭痛、肢體功能障礙為主要臨床症狀。組織學表現為核分裂增多≥4/10H P F有7例、細胞密度高9例、小細胞伴核漿比升高4例、細胞可見明顯核仁8例、無定型片狀生長9例、壞死6例及浸潤周圍腦組織6例。免疫組織化學染色:腫瘤細胞9例均EMA陽性及Vimentin陽性、GFAP陰性。Ki-67增殖指數平均為5%。9例中6例PR陽性。全部病例隨訪結果,2例復發(22%)。結論非典型腦膜瘤是一種高復發性的腦腫瘤,復發可能與周圍腦組織浸潤相關。

Objective To investigate the clinicopathological features and recurrence rate of atypical meningioma(AM)after operative removal.Methods The clinicopathologic data,MRI,morphological features and immune-histochemical characteristics were reviewed in 9 cases of AM.The survival and recurrence were assessed during followed-up visits.Results Among the 9 cases of AM,there were 4 males and 5 females.The age ranged from 3~69 years old.The tumor most commonly occurred in frontal lobe attached to falx cerebri.Main symptoms were headache and physical dysfunction.Microscopically,increased mitotic activity(>4 mitoses per 10 high powered fields)was observed in 7 cases,increased cellularity in all 9 cases,small cells with a high nuclear to cytoplasmic ratio in 4 cases and prominent nucleoli in 8 cases.All 9 cases of tumors grew in uninterrupted pattern lessor sheet-like pattern,with 6 cases showing focal necrosis and brain-invasion.Immunohistochemically,the tumor cells of all cases were positive for EMA,Vimentin,and negative for GFAP.PR was positive in6 cases.The mean Ki-67 proliferation index was 5%.All cases were followed up for 2 to 54 months,Two cases(22%)recurred after operation.Conclusion AM as meningioma has high recurrence rate.The recurrence was likely related to brain-invasion.