颅咽管瘤钙化程度与骨桥蛋白的关系

目的通过检测颅咽管瘤组织中骨桥蛋白(OPN)的表达量来分析OPN与颅咽管瘤钙化的关系。方法收集本单位自2004年5月至2006年3月手术的颅咽管瘤标本共54例,根据术中所见及影像学结果分析钙化程度,采用HE染色分析组织类型,免疫组化SP法检测OPN的表达情况;结合临床资料分析钙化程度与OPN表达强度的关系。结果肿瘤分两种类型即成釉细胞型(41例),鳞状细胞型(13例)。经Mann-WhitneyU检验分析,OPN表达程度在成釉细胞型与鳞状细胞型之间存在显著性差异(Z=-4.813,P<0.001),成釉细胞型颅咽管瘤的表达显著高于鳞状细胞型颅咽管瘤。经Spearman相关分析,在成釉细胞型中随着钙化程度的增加,OPN表达程度显著增强(rs=0.533,P<0.01)。结论OPN与颅咽管瘤的钙化密切相关,推测是影响颅咽管瘤钙化程度的重要因素。     

颅咽管瘤骨桥蛋白免疫组化及免疫电镜研究

目的通过研究颅咽管瘤的超微结构及其与钙化的关系,探讨颅咽管瘤钙化形成的分子基础进一步明确骨桥蛋白(os-teopontin,OPN)在其钙化过程中的作用。方法免疫组化SP法检测OPN在54例颅咽管瘤组织中的表达情况,结合临床资料分析钙化程度与OPN表达强度的关系。对颅咽管瘤组织超微结构进行透射电镜观察,并从超微定位水平检测OPN在颅咽管瘤中的表达。结果透射电镜明确颅咽管瘤的超微结构。经Spearman相关分析,在成釉细胞型中随着钙化程度的增加,OPN表达程度显著增强(rs=0.533,P<0.01)。经Mann-WhitneyU检验分析,OPN表达程度在成釉细胞型与鳞状细胞型之间差异有统计学意义(Z=-4.813,P<0.001),成釉细胞型颅咽管瘤的表达显著高于鳞状细胞型颅咽管瘤。OPN免疫电镜显示OPN主要定位于肿瘤细胞胞浆的内质网上。结论OPN可能是颅咽管瘤的钙化过程中重要的影响因素。     

颅咽管瘤钙化与骨化关系的研究

目的 通过对颅咽管瘤超微结构的研究,病理学及影像学资料的复习,探讨颅咽管瘤骨化特点及其形成机制. 方法 收集南方医科大学南方医院神经外科自2004年5月至2006年3月手术的颅咽管瘤标本54例,其中男31例;女23例.术后病理证实为成釉细胞型颅咽管瘤41例,鳞状细胞型颅咽管瘤13例.分析肿瘤标本的显微结构、组织类型、骨化的特征.透射电镜分析颅咽管瘤骨化的超微结构基础,结合手术及影像学资料,分析颅咽管瘤骨化及其与钙化的关系. 结果 成釉细胞型颅咽管瘤钙化情况:7例(-),11例(+),11例(++),12例(++++);鳞状细胞型颅咽管瘤钙化情况:13例(-).镜下可见蛋壳样钙化及大块钙化的颅咽管瘤存在骨化,而在鳞状细胞型颅咽管瘤、无钙化及砂粒样钙化的成釉细胞型颅咽管瘤标本中未见骨化的现象;骨化结构的分布与钙化的程度密切相关. 结论 颅咽管瘤骨化的发生与钙化程度存在密切的联系,钙化是颅咽管瘤骨化的基础,骨化的形成使原本没有生物学活性的钙化结构变成含有肿瘤细胞、肿瘤间质的复合体,为术后残留的钙化组织导致肿瘤复发提供了基础.     

颅咽管瘤侵袭第三脑室的方式对手术切除的影响

目的 探讨大型颅咽管瘤与第三脑室的关系在肿瘤切除手术中的意义. 方法 南方医科大学南方医院神经外科白1997年1月至2003年1月共采用手术治疗大型颅咽管瘤患者72例.根据肿瘤的影像学表现及手术所见对其进行分类,每一类肿瘤根据大小及其与第三腩室底的关系分为3级,根据术中判断和术后CT和(或)MPd增强扫描结果确定颅咽管瘤手术切除程度,分析肿瘤分级与手术切除程度的关系. 结果颅咽管瘤总体上可以分为第三脑室内型(本组7例)和第三脑室累及型(本组65例)两大类;手术切除程度在不同分级肿瘤间总体分布位置不同,差异有统计学意义(P<0.05). 结论 明确大型颅咽管瘤与第三脑室底及下丘腩结构间的关系对提高大型颅咽管瘤手术疗效有重要意义.     

颅咽管瘤钙化与CD44V6的关系

目的分析颅咽管瘤组织中CD44V6的表达与颅咽管瘤钙化的关系。方法收集2004年5月～2006年3月经手术治疗的颅咽管瘤标本54例。根据术中所见及影像学表现确定肿瘤钙化程度，采用苏木精一伊红染色分析肿瘤组织类型，免疫组化法检测CD44V6在肿瘤组织中的表达情况。结合临床资料分析钙化程度与CD44V6表达强度的关系。结果成釉细胞型颅咽管瘤41例，鳞状细胞型颅咽管瘤13例。经Mann—Whitney U检验分析，成釉细胞型颅咽管瘤CD44V6的表达显著高于鳞状细胞型颅咽管瘤（Z=-4．813，P〈0．001）。经Spearman相关分析，在成釉细胞型中随着钙化程度的增加，CD44V6表达程度显著增强（rs=0．527，P〈0．01）。结论CD44V6与颅咽管瘤的钙化密切相关，可能是影响其钙化程度的重要因素。     

SYBR荧光实时定量PCR检测不同病理类型颅咽管瘤ICAM-1 mRNA表达

目的定量研究细胞间粘附分子基因(ICAM—1 mRNA)在不同病理类型颅咽管瘤的表达差异及意义。方法收集30例经手术治疗的颅咽管瘤标本,采用SYBR荧光实时定量PCR法检测 ICAM-1 mRNA在肿瘤组织的表达,并对表达结果行统计学分析。结果造釉细胞型颅咽管瘤 ICAM-1mRNA表达量为(62．18±6．43)×103 copies／μg,鳞状乳头型颅咽管瘤ICAM-1 mRNA表达量为 (1．13±0．17)×103 copies／μg,造釉细胞型颅咽管瘤ICAM-1 mRNA表达量显著性高于鳞状乳头型颅咽管瘤(P<0．01)。结论两种病理类型颅咽管瘤ICAM—1 mRNA表达存在显著性差异,此差异性可能与两种病理类型颅咽管瘤不同的肿瘤炎症有关。     

颅咽管瘤组织炎性反应与临床病理和肿瘤预后相关性分析

目的 探讨颅咽管瘤不同炎性反应等级与临床病理、肿瘤预后的相关性.方法 根据临近肿瘤正常组织交界处的炎性反应细胞数量对颅咽管瘤进行炎性反应评估,结合临床资料,对49例经手术治疗的颅咽管瘤病例进行回顾性分析并探讨其与临床病理和肿瘤预后的相关性.结果 颅咽管瘤组织炎性反应与肿瘤病理类型(x2=6.603,P =0.037)、全切率(x2=8.188,P=0.017)、钙化(γ=0.326,P=0.022)、术后患者下丘脑功能评分(γ=0.376,P=0.008)和手术难易度(γ =0.515,P＜0.001)相关.结论 颅咽管瘤起源、生长方式及组织炎性反应程度可能是决定颅咽管瘤预后的重要因素.     

颅咽管瘤组织炎症与术后尿崩关系的探讨

目的研究颅咽管瘤组织炎症与术后尿崩程度的关系。方法对30例经手术治疗的颅咽管瘤病例进行回顾性分析,并采用免疫组化SP法检测毗邻下丘脑的颅咽管瘤组织中白细胞共同抗原CD45,以标记炎性细胞。根据CD45标记的炎性细胞数量将肿瘤炎症分为4级,术后尿崩按发生程度分为轻度尿崩、中度尿崩及重度尿崩,并对它们之间的关系进行分析。结果CD45标记的炎症反应在毗邻第三脑室底部的颅咽管瘤组织中广泛存在,炎症Ⅰ级(0.0%,0/5)和Ⅱ级(0.0%,0/8)患者重度尿崩发生率明显低于(P<0.05)Ⅲ级(25.0%,3/12)和Ⅳ级者(60.0%,3/5)。结论颅咽管瘤组织炎症与术后尿崩程度有关,分析颅咽管瘤组织炎症有助于预测术后尿崩发生的严重程度。     

颅咽管瘤中BCL-2蛋白的表达及意义

目的　分析颅咽管瘤中凋亡抑制基因BCL - 2在蛋白水平的表达 ,探讨其在颅咽管瘤生长机制中的意义。方法　选取经手术及病理证实的颅咽管瘤 4 9例 ,采用免疫组化法检测BCL 2蛋白的表达。结果　BCL 2的阳性表达程度在不同病理类型的颅咽管瘤上有显著差异 ,造釉细胞型颅咽管瘤的表达强度显著高于鳞状乳头型颅咽管瘤 (P <0 0 1)。结论　BCL 2在不同病理类型的颅咽管瘤中的表达呈现明显的区别 ,提示 :凋亡调控机制的失控可能是造釉型颅咽管瘤生长的重要机制之一 ;胚胎残余组织的继续增殖学说更能解释造釉细胞型颅咽管瘤的起源可能。     

炎症相关因子IFN-α及TGF-β1在颅咽管瘤的表达及意义

目的探讨炎症相关因子IFN-α、TGF-β1与颅咽管瘤炎症反应的关系。方法采用免疫组化GTVisionTM法检测α-干扰素(interferon-α,IFN-α)、转化生长因子-β1(transforming growth factorβ1,TGF-β1)在58例颅咽管瘤组织中的表达情况,比较不同病理类型颅咽管瘤、复发组及初发组颅咽管瘤组织中IFN-α、TGF-β1的表达水平。结果造釉细胞型及复发颅咽管瘤IFN-α表达广泛。44例造釉细胞型颅咽管瘤有40例IFN-α表达阳性(90.91%),鳞状乳头型14例中有12例表达阳性,造釉细胞型IFN-α阳性表达率明显高于鳞状乳头型(Z=-2.003,P<0.05)。16例复发颅咽管瘤均有IFN-α阳性表达,阳性表达率高于初发组(Z=-2.085,P<0.05)。TGF-β1在鳞状乳头型颅咽管瘤明显表达,14例中有10例阳性表达,而造釉细胞型44例仅有14例表达阳性(Z=-2.129,P<0.05)。经Spearman相关分析,在全部颅咽管瘤中,IFN-α与TGF-β1表达程度呈负相关(rs=-0.273,P<0.05)。结论颅咽管瘤存在复杂的炎症反应,炎症相关因子IFN-α、TGF-β1可能参与颅咽管瘤细胞的生长调控,两者之间可能存在拮抗作用。     

An ultrastructural study of mineralization in craniopharyngiomas

In eight cases of adamantinomatous craniopharyngioma examined ultrastructurally special attention was paid to the process of mineralization. The tumors were usually composed of neoplastic epithelial cells and fibrous connective tissue stroma. Islands of keratinized cells were frequently observed in the epithelial cell zone. In most of the degenerated keratinized cells cytoplasmic organelles had disappeared except for tonofibrils and membrane-bound round vesicles were seen among the numerous tonofibrils. Needle-shaped crystals were deposited within some vesicles. The accumulation of crystals in the vesicles and the coalescence of calcified vesicles and calcified adjacent tonofibrils resulted in the formation of a large calcified body. Mineralized precipitates were confirmed as calcium and phosphorus by means of an energy dispersive X-ray microanalyzer; the precipitates were composed of hydroxyapatite which was substantiated crystallographically with an X-ray diffractometer. These findings suggest that membrane-bound vesicles derived from degenerated keratinized cells play an important role in the initial process of calcification. The tonofibrils may also serve to orient apatite crystal precipitation.     

Large Ossified Rathke's Cleft Cyst - A Case Report and Review of the Literature -

We report a rare case of symptomatic Rathke''s cleft cyst with thick calcified wall. Brain CT scans revealed a large cystic mass with round thick calcified wall. In this case, we selected the pterional approach instead of transsphenoidal approach due to the possibility of cystic craniopharyngioma. Histopathologically, it was calcified Rathke''s cleft cyst with focal epithelial metaplasia. This case illustrates that calcification of the suprasellar cyst does not always suggest craniopharyngioma and the calcification pattern of Rathke''s cleft cyst is different from that of the craniopharyngioma.     

Pedicled craniopharyngioma of the 3d ventricle

A 62 year-old man suffered of headache and progressive walking difficulties for 4 years. Radiological examinations showed a calcified intraventricular tumor attached to the floor of the 3rd ventricle. Death, caused by septicemia, occurred before neurosurgery. On sagittal braincut the tumor appeared pediculated and was attached to the anterior part of the floor of the 3rd ventricle. The microscopic features were those of typical craniopharyngioma. The pedicle and the floor of the 3rd ventricule were devoid of tumoral cells. Numerous large vessels which originated in the basal leptomeninges were present in the ventricular floor and the pedicle and then branched out into the tumor. Pathologically proven purely intraventricular craniopharyngiomas have been seldom reported. To our knowledge an autopsy case of pediculated intraventricular craniopharyngioma has been previously described only once, without particular attention to the pedicle. The integrity of the floor of the 3rd ventricle constitutes the only feature that may differentiate with certainty an intraventricular extension of a suprasellar craniopharyngioma from a pure intraventricular form of this tumor.     

Energy expenditure in obesity associated with craniopharyngioma

Background and purpose

Obesity is a common yet incompletely understood complication of childhood craniopharyngioma. We hypothesized that craniopharyngioma is associated with specific defects in energy balance compared to obese control children.

Methods

Eleven craniopharyngioma patients were recruited for a study on body composition and energy balance. Eight subjects were obese. The obese craniopharyngioma patients had a mean age (±SD) of 11.2?±?1.7 years. The average body mass index z score was 2.33 (±0.32). A previously studied group of obese children (BMI z score 2.46?±?0.46) served as controls. Resting energy expenditure (REE) was determined by indirect calorimetry and body composition by dual energy X-ray absorptiometry in all children.

Results

Obese craniopharyngioma patient subjects had increased mean (±standard error) fat-free mass compared to obese controls (57%?±?0.88 % vs 50.0%?±?0.87%, p?=?0.02). The obese craniopharyngioma patients had a 17% lower REE compared to values expected from the World Health Organization equation (1,541?±?112.6 vs 1,809?±?151.8 kcal; p?=?0.01). In contrast, the obese control children had measured REE within 1% of predicted (1,647?±?33.2 vs. 1,652?±?40.2; p?=?0.8). In a linear regression model, REE remained significantly lower than predicted after controlling for FFM.

Conclusions

Lower REE may be a factor contributing to obesity in children with craniopharyngioma. Further study is needed into the mechanisms for reduced energy expenditure in patients with craniopharyngioma.     

循证护理在预防颅咽管瘤术后并发症中的应用

目的探讨循证护理模式在预防颅咽管瘤术后并发症中的作用。方法对2006-01~2008-02在本院行手术治疗的21例颅咽管瘤患者应用循证护理模式进行护理。结果21例颅咽管瘤患者术后并发症发生率低,均得到良好控制。结论循证护理对预防颅咽管瘤术后并发症具有重要作用。     

Moyamoya syndrome precipitated by cranial irradiation for craniopharyngioma in children

Recently, combination of surgery and radiation therapy (RT) has been recommended in the treatment of craniopharyngioma. RT could be associated with late complications, including vasculopathy. We report two cases of the moyamoya syndrome seen in children with craniopharyngioma who received RT after surgical resection. Thirty-five patients in pediatric age with craniopharyngioma were surgically treated. Fifteen out of 35 patients underwent surgical resection followed by RT or gamma knife surgery. Two of the 15 were found to have symptoms of transient ischemic attack and were diagnosed as moyamoya syndrome through the cerebral angiography. Age at RT was 4 and 13 years, respectively. The latent period for development of the moyamoya syndrome was 27 months and 3 years, respectively, after RT. The RT dose of both patients was 54 Gy. These two patients received bilateral encephaloduroarteriosynangiosis procedures. We report here these two cases of radiation-induced moyamoya syndrome in pediatric craniopharyngioma. Pediatric patients with craniopharyngioma who received RT should be reminded, during follow-up, about the risk of development of the moyamoya syndrome.     

颅咽管瘤细胞周期特点及其临床意义

目的 检测颅咽管瘤(CP)的细胞增殖、凋亡指数及细胞周期动力学特点,观察与肿瘤复发的关系.方法 采取前瞻性队列研究方案,流式细胞技术(FCM)检测肿瘤细胞的染色体变化及增殖、凋亡分数,测定CP组织细胞s期分数,Tanel·POD法测定肿瘤细胞凋亡,结合电镜观察肿瘤超微结构及与周界正常组织关系,评价CP亚型釉质上皮型/鳞形上皮型、复发组/非复发组、原发组/复发组间瘤细胞周期动力学特点.结果 CP细胞为二倍体,釉质上皮型肿瘤实质部分坏死、凋亡率小于鳞形上皮瘤实质成分(P<0.05),但二型肿瘤细胞凋亡率均较低下;釉质上皮型肿瘤细胞较鳞形上皮型增殖活性强,前者S期分数、G2/M+s值也显著高于后者,釉质上皮瘤、鳞形上皮瘤复发组和非复发组比较也得出类似结果(P相似文献   

Calcified cerebral hydatid cyst

A 32-year-old patient with a lifelong history of epileptic attacks is described. A skull X-ray showed a round calcified nonhomogenous left frontotemporal mass. A CT scan confirmed its presence, as well as displacement of the left lateral and the third ventricles. At surgery a calcified inactive hydatid cyst was totally removed. Full recovery took place two months later. A differential diagnosis of hydatic cysts should be made when a calcified brain mass is found in patients from an endemic echinococcosis area.     

Metastatic craniopharyngioma: case report and literature review

Background  Distant spread of craniopharyngioma is a rare but important complication. Most cases are a result of spread along the surgical path. We describe a rare case of metastatic leptomeningeal craniopharyngioma as a result of dissemination along CSF pathways in a child. A review of previously described cases is provided. Case presentation  A 14-year-old male was diagnosed with metastatic craniopharyngioma on routine follow-up imaging after multiple surgeries and radiation for locally recurrent craniopharyngioma. The lesion was erosive through the right parietal bone, but had remained clinically silent. The lesion was distant from previous surgical paths. The patient underwent right parietal craniotomy and resection of the lesion. Duraplasty and cranioplasty were necessary for closure. Histopathology confirmed adamantinomatous craniopharyngioma. One-year follow-up demonstrated no recurrence. Discussion  A review of reported cases suggests that leptomeningeal implantation may be an important step in metastases of craniopharyngioma, although the mechanism is poorly understood. Attention to tumor spillage at the time of surgery may be important in preventing distant recurrences.