Anton’s syndrome due to a giant anterior fossa meningioma. The problem of routine use of advanced diagnostic imaging in psychiatric care

Summary We present a case of blindness and Anton’s syndrome in a psychiatric patient with late diagnosis of a giant frontal meningioma. The criteria for advanced diagnostic imaging in the psychiatric population are discussed. We conclude that MR or CT scan is indicated in psychiatric in-patients who fail to improve with standard psychiatric treatment. This strategy should be submitted to a cost-benefit analysis.     

缺氧诱导因子-1的表达与脑膜瘤血管生成的关系

目的探讨缺氧诱导因子-1(HIF-1)的表达与脑膜瘤血管生成的关系。方法采用免疫组织化学方法检测48例脑膜瘤和10例正常脑膜组织中氧诱导因子-1α(HIF-1α)的表达,并用人原始造血细胞(CD34)抗体标记血管内皮细胞,计数脑膜瘤和正常脑膜组织中的微血管密度(MVD),对所得资料进行统计学分析。结果48例脑膜瘤组织中,HIF-1α阳性表达率为79%,其中弱阳性( ),阳性( ),强阳性( )表达率分别为33%,31%,15%;MVD为6~55,x±s为28±11;正常脑膜中无HIF-1α表达,MVD为4±1,明显低于肿瘤组织,差异有显著性(P<0.01)。HIF-1α阴性(-)表达者,MVD为11±5;呈弱( )、中( )及强阳性( )表达者,MVD分别为23±10、36±13及47±15;HIF-1α阳性表达程度与MVD呈正相关(rs=0.766,P<0.01)。结论HIF-1的表达与脑膜瘤血管生成密切相关,进一步研究HIF-1在脑膜瘤中的表达及调控血管生成的机制,可能为脑膜瘤的治疗开辟新途径。     

镰旁大型脑膜瘤外科治疗的探讨

目的：探讨影响镰旁大型脑膜瘤手术治疗的相关问题。方法：回顾性分析1994年8月至2001年8月经治的12例镰旁大型脑膜瘤的临床资料及手术经过。结果：12例肿瘤均全切除，无手术死亡。随访预后良好，无肿瘤复发。结论：镰旁大型脑膜瘤的手术应充分利用影像学资料及病人出现的阳性体征进行分析，选择合适的手术径路全部切除肿瘤，同时注重脑功能区及重要血管的保护、瘤基底部大脑镰的切除及周边组织的电灼处理。     

脑膜瘤端粒酶的活性在判断复发和恶变中的价值

【目的】探讨端粒酶作为脑膜瘤标志物 ,在肿瘤良恶性鉴别、恶性程度评估以及预后预测等方面的意义。【方法】利用TRAP ELISA方法定量检测 6 1例 (份 )肿瘤标本端粒酶的活性 (以ΔA =A4 50 -A690 表示 ) ,结合肿瘤的分类和患者的临床资料 ,分析端粒酶活性作为肿瘤良恶性及判断预后的标记物的可行性。另取正常脑组织标本 2 0例作为对照。【结果】 30例脑膜瘤中 ,2 9例脑膜瘤均未测到端粒酶活性 ;1例端粒酶阳性 (阳性率 3 3%) ,ΔA =0 2 37;全组ΔA平均值 =0 0 49。 15例恶性脑膜瘤中 14例呈端粒酶阳性 (93%) ,ΔA =1 2 37～ 2 5 16 ;1例端粒酶阴性 ,ΔA =0 0 76 ,全组ΔA平均值 =1 6 30。 16例复发性脑膜瘤端粒酶均阳性 (10 0 %) ,ΔA =1 0 34～ 1 4 78,平均 1 2 5 5。脑膜瘤和复发性脑膜瘤、脑膜瘤和恶性脑膜瘤的端粒酶的阳性率和酶活性表达强度方面差异明显 (P分别为 <0 0 0 1、<0 0 1和 <0 0 0 0 5、<0 0 1)。 2 0例正常脑组织中未检测到端粒酶活性。【结论】端粒酶活性的激活在恶性脑膜瘤和复发性脑膜瘤中是较常见的现象。端粒酶作为肿瘤标志物 ,在脑膜瘤的良恶性鉴别、恶性程度评估、预后预测等方面具有重要的意义。     

Expression of the c-erbB-2-encoded oncoprotein and progesterone receptor in human meningiomas

The present study investigated the expression of c-erbB-2 in 59 meningiomas, including different histological subtypes and anaplastic variants, by immunocytochemistry and molecular biological techniques. Immunohistochemistry using the monoclonal antibody FWP-51 directed against c-erbB-2-encoded oncoprotein gp185 demonstrated variable degrees of immunoreactivity in all meningiomas. The intensity of immunostaining correlated with the degree of expression as assessed by Western analysis in 28 meningiomas using polyclonal antiserum 21N. There was no correlation between the degree of expression and histological variants. Immunoreactivity of all menigiomas was distinctly less intense, however, than that of the human breast cancer cell line SK-BR-3, and slightly lower than that of brain metastases of breast and ovarian carcinomas that served as positive controls for both methods. By Southern analysis all meningiomas showed a single copy of the c-erbB-2 gene. Non-neoplastic arachnoid cap cells also exhibited c-erbB-2 expression and the degree of immunoreactivity was comparable with the majority of meningiomas. These data argue against an overexpression of c-erbB-2 in meningiomas, but rather indicate a cell-type-specific constitutive expression of the c-erbB-2 gene product in meningiomas and their putative progenitor cells. Since a subgroup of meningiomas is known to express progesterone receptors (PR), gp185 immunoreactivity was compared to the hormone receptor status using monoclonal antibody KD68. Fifty-six percent meningiomas showed PR immunoreactivity, but there was no statistically significant correlation with the degree of gp185 expression.This study was supported by a grant of the Tumorzentrum Heidelberg/Mannheim (M.K., No. 10028060)     

Intracranial Non-Hodgkin’s MALT lymphoma mimicking a large convexity meningioma

Summary Primary presentation of an intradural Non-Hodgkin’s lymphoma is rare. Recently these B cell lymphomas of mucosa associated lymphoid tissue (MALT) have gained acceptance as an important pathological subtype and are distinguishable from other primary CNS lymphomas that exhibit aggressive behaviour. Over the past decade a number of these lesions have been reported to resemble a meningioma both intra-operatively and radiologically. The authors outline such a case of marginal zone B cell lymphoma that clinically and radiologically resembled a meningioma. This case illustrates the rare occurrence of low grade dural B cell lymphoma and the need to consider this entity in the differential diagnosis of CNS lesions, if appropriate targeted therapy is to be administered.     

老年人脑膜瘤外科治疗及预后判断

目的:探讨老年人脑膜瘤的临床特点,手术治疗以及影响预后的因素。方法:本组老年脑膜瘤患者共30例,均行肿瘤切除手术。结果:30例患者中,肿瘤全切25例,部分切除5例,手术后开发症5例,手术前Karnofsky评分小于70、肿瘤直径大于4.5cm、瘤周存在严重水肿与手术后并发症显著相关。结论:老年脑膜瘤患者手术治疗的预后受多种因素影响。     

良、恶性脑膜瘤性激素受体和外源凝集素受体的检测

采用 ABC 免疫组化技术对82例脑膜瘤活检组织(良性脑膜瘤67例、恶性脑膜瘤15例)进行了三种性激素受体和12种 LR 的测定.结果证实脑膜瘤是性激素的靶组织,ER阳性率74.4%,PR 阳性率75.6%。AR 阳性率29.3%.ER 阳性率与性别有关,女性高于男性;PR 阳性率与组织类型有关,脑膜内皮型阳性率最高,过渡型居中,而纤维母细胞型及砂粒体型阳性率较低;AR 阳性率与组织分化程度有关,恶性脑膜瘤中 AR 阳性率高于良性脑膜瘤中 AR 阳性率.这些结果为进一步探讨性激素受体在脑膜瘤的生物学行为上所起的作用及对脑膜瘤实施内分泌治疗提供理论依据.12种 LR 中只有 PSA 受体在良性脑膜瘤中的阳性率高于恶性脑膜瘤,故这一结果可作为良、恶性脑膜瘤诊断的依据.三种性激素受体与 LR 染色结果经配对卡方检验证明无相关性,因此 LR 的测定不能代替性激素受体的测定.     

不典型性脑膜瘤52例CT诊断分析

回顾性分析了22例少见部位的脑膜瘤，22例CT表现不典型及8例CT误诊脑膜瘤的CT表现，以确定脑膜瘤不典型表现与CT误诊的关系。结果显示脑膜瘤的CT误诊多数缘于经验不足与疏忽，少数为极不典型表现所致。若检查全面、阅片仔细．术前CT定性率可由90％提高至96．25％。     

内侧型蝶骨嵴脑膜瘤的显微外科治疗

目的 提高内侧型蝶骨嵴脑膜瘤的全切率,降低病死率和致残率.方法 对25例内侧型蝶骨嵴脑膜瘤显微外科治疗病例的临床资料进行回顾性分析.结果 冠状位计算机体层摄影术有助于判断肿瘤的生长点.磁共振成像可显示肿瘤与海绵窦、颈内动脉的关系.1例肿瘤侵入海绵窦,11例肿瘤包绕颈内动脉和主要分支.肿瘤附着点为前床突和(或)小翼的内侧.18例达Simpson Ⅰ、Ⅱ级全切除.无手术死亡,疗效满意.结论 显微手术可明显提高肿瘤全切率,减少术后并发症,降低病死率.手术要点是尽早离断肿瘤基底并沿颈内动脉床突上段由近向远分离切除包绕的肿瘤.由于多数存在肿瘤与血管之间的蛛网膜界面,提倡在第1次手术中采用积极的显微外科治疗.