微囊型脑膜瘤临床病理、超微结构和免疫组化研究

目的：提高对颅内微囊型脑膜瘤的认识，提高诊断本领。方法；对15例颅内微囊型脑膜瘤进行光镜、超微结构和免疫组化三个方面进行了研究。结果：光镜下肿瘤细胞质淡染有长的突起，间质丰富有许多空泡状微囊。小血管多，肿瘤内无砂粒体或坏死。电镜下，肿瘤细胞胞质伸出指状突起相互围成囊腔，囊内可见束状胶原纤维丝。免疫组化，Vimetin和EMA染色阳性。结论：光镜下该型脑膜瘤具有一定特征，免疫组化有助于该瘤的诊断，电镜可以正确诊断微囊型脑膜瘤。     

脑膜瘤CT、MR 表现与病理-超微结构和免疫组化对照研究

 目的　提高 CT、MR对脑膜瘤的诊断水平。方法　 5 2 9例经 CT检查 5 1 5例 ,MR检查78例 ,均经手术病理证实。按 1 990年 WHO脑膜瘤新分类进行光镜分类 ,配合 JEM- 1 0 0透射电镜观察超微结构 ,作 6种肿瘤的免疫组织化学检测波形蛋白 ( Vimentin) ,胶质纤维酸性蛋白( GFAP) ,角蛋白 ( Keratin) ,S- 1 0 0蛋白 ,上皮膜抗原 ( EMA) ,黑色素瘤抗原 ( HMB45 )。结果　对CT显示混合密度、囊性低密度区 ;MR呈长 T1、长 T2等信号与电镜所见瘤细胞空泡状 ,突起交织形成囊状超微结构的微囊型脑膜瘤为密切关系。其它良、恶性脑膜瘤的 CT、MR表现与电镜显示肿瘤超微结构均为密切关系。对病理分类的 1 2种良、恶性脑膜瘤检测显示 Vimentin和 EMA均为阳性。结论　对 CT、MR可疑脑膜瘤和电镜较难确诊者 ,应配合电镜进行肿瘤超微结构观察和肿瘤免疫组化检测确诊.     

微囊型脑膜瘤2例临床病理学特征分析并文献复习

背景与目的：微囊型脑膜瘤是脑膜瘤的罕见亚型,国内外报道较为少见,且多以个案报道为主。本研究旨在探讨微囊型脑膜瘤的临床病理学特点及鉴别要点。方法：回顾分析2例微囊型脑膜瘤的临床表现、组织学形态及免疫组织化学表型,并复习相关文献。结果：2例均为中年患者,男性和女性各1例,男性患者因外伤引起脑出血就诊;女性患者因头痛就诊,病变分别位于左侧额部和右侧额部,最大径分别为5.75和5.47 cm。影像学改变均示“脑外肿瘤”。镜下瘤细胞排列疏松,形成大小不等的微囊,腔内含粉染之浆液,肿瘤细胞具有空泡状细胞质和细长的细胞质突起,典型的漩涡状结构和砂粒体少见。免疫组织化学示,波形蛋白（vimentin）、上皮膜抗原（epithelial membrane antigen,EMA）和孕激素受体（progesterone receptor,PR）均呈阳性表达,S-100、胶质纤维酸性蛋白（glial fibrillary acidic protein,GFAP）、CD34和肌酸激酶（creatine kinase,CK）均呈阴性表达,Ki-67阳性率达3%~5%。2例患者均行手术治疗,术后均随访观察,随访时间为5~6个月,截至2018年1月,2例患者一般情况良好,均未见肿瘤复发。结论：微囊型脑膜瘤为脑膜瘤的特殊亚型,依据病理组织学形态及免疫组织化学可明确诊断。目前治疗主要以手术治疗为主,预后良好。     

平滑肌肉瘤的临床病理研究：——病理组织学,免疫组化及超微结构分析

本文报告对２６例全身多个部位的平滑肌肉瘤（ＬＭＳ）的病理组织学、ＲＨＦ３５及Ｄｅｓｍｉｎ免疫组化及部分病例还进行了超微结构特征研究。结果表明ＬＭＳ具有较典型的组织学特征：瘤细胞呈杆状，平行排列，胞浆内有肌原纤维。低分化的ＬＭＳ细胞异型性大，但仍具有上述特征。Ｄｅｓｍｉｎ标记ＬＭＳ的阳性率是６５％，ＨＨＦ３５的阳性率是９６％。两者有显著性差异。其它对照的多种梭形细胞肉瘤中，除恶性纤维组织细胞瘤中可有     

4种少见脑膜瘤的临床病理观察

报告４种少见的脑膜瘤亚型：分泌型、微囊型、脂肪瘤和黄色瘤型。临床表现主要有头痛、恶心、轻度呕吐、眼底水肿和肢体功能障碍。形态学：分泌型脑膜瘤以散在多个嗜酸性近圆形包含体为特征，包含体对ＣＥＡ、ＥＭＡ呈特异性表达；微囊性脑膜瘤含微小囊腔状如海绵，囊内含粉染浆液，囊壁由疏松和涡漩状排列之瘤细胞组成；脂肪瘤和黄色瘤型脑膜瘤分别在其瘤组织中含有大量脂肪细胞或泡沫细胞为特征。文中讨论了肿瘤形成机制及鉴别要点。     

平滑肌肉瘤的临床病理研究─—病理组织学、免疫组化及超微结构分析

本文报道对２６例全身多个部位的平滑肌肉瘤（ＬＭｓ）附病理组织学、ＨＨＦ３５及Ｄｅｓｍｉｎ免疫组化及部分病例还进行了超微结构特征研究。结果表明ＬＭＳ具有较典型的组织学特征：瘤细胞呈杆状，平行排列，胞浆内有肌原纤维。低分化的ＬＭＳ细胞异型性大，但仍具有上述特征。Ｄｅｓｍｉｎ标记ＬＭＳ的阳性率是６５％，ＨＨＦ３５的阳性率是９６％。两者有显著性差异。其它对照的多种梭形细胞肉瘤中，除恶性纤维组织细胞瘤中可有少数、单个的细胞呈ＨＨＦ３５阳性外，其它均不表达ＨＨＦ３５和Ｄｅｓｍｉｎ。因此ＨＨＦ３５是标记ＬＭＳ的敏感性高、特异性强的抗体。透射电镜观察ＬＭＳ具有特征性的密体和密斑存在。透射电镜观察也是确诊ＬＭＳ的途径之一。     

胃癌细胞内微囊超微结构的研究

本文通过一组胃癌病例描述了细胞内微囊的超微结构及其诊断意义。全组75例胃癌中17例在癌细胞中发现微囊。电镜下,微囊乃细胞浆内的一种特殊结构,为与外界不相通的孤立囊腔,内表面披以微绒毛,囊腔内含有低电子密度的颗粒状物质。关于微囊的组织来源,作者推测可能来自二级溶酶体。由于微囊常见于胃癌而在其他癌瘤中罕见,故对胃癌的诊断具有一定的意义。     

脊索样脑膜瘤四例临床病理分析

目的 作为脑膜瘤的一种罕见亚型,脊索样脑膜瘤因不具备典型脑膜瘤的病理特征,常难以同脊索瘤及其他肿瘤区分,易造成误诊.本研究旨在通过探讨脊索样脑膜瘤临床病理特征、免疫表型及MRI特征表现,进一步提高对该亚型脑膜瘤的认识.方法 收集兰州大学第二医院2010-10-01-2015-10-25经手术后病理确诊的4例脊索样脑膜瘤患者临床资料,分析临床病理特征及影像资料,结合相关文献进行对比研究.结果 光镜下,4例HE染色示组织学类似脊索瘤,瘤组织排列成束状或小梁状分布于黏液样基质中,瘤细胞胞质丰富,嗜酸,并可见胞质内空泡,部分区域为典型脑膜瘤漩涡状、束状、编织状结构,2例瘤组织间可见少量淋巴细胞、浆细胞浸润.免疫表型示,瘤细胞EMA(+)、Vimentin(+)、CKp(-)、S-100(-)、GFAP(-),Ki-67阳性细胞数平均为8％.MRI示,4例均为单发病灶,3例位于顶叶,1例位于额颞叶;2例为实性类圆形,1例呈不规则团块状,1例为囊实性,实性呈结节状附壁生长;2例病灶界限不清,2例边界清晰;4例瘤周水肿明显,邻近脑组织均有不同程度受累;T1WI 4例呈等、略低信号;T2WI 3例呈等、略高信号,1例呈等、略低信号.结论 诊断脊索样脑膜瘤,应结合形态学、相应的免疫组化染色及具有一定表现特征的影像学检查,以有效降低误诊率.     

透明细胞型脑膜瘤的临床病理特征

透明细胞型脑膜瘤（clear cell meningioma,CCM）是一种少见的脑膜瘤亚型,好发于脊柱、桥脑小脑部位,患者发病年龄较轻,因肿瘤细胞的胞浆富含糖原呈透明状而得名。CCM的组织学结构特征为玻璃样变性的胶原混杂于温和的肿瘤细胞间,虽然组织学形态和善,但可呈侵袭性生长,具有较高的复发率,并可通过脑脊液播散[1],因此,在2000年,世界卫生组织(WHO)将CCM归为Ⅱ级神经系统肿瘤。本研究中,我们分析了3例CCM的临床病理特点、鉴别诊断和预后等,现将结果报告如下。     

225例大肠腺瘤癌变的临床病理、免疫组化及其超微结构

目的：探讨大肠腺瘤及其癌变的临床病理、免疫组织化学及其超微结构。方法：随机选择我院近5年间纤维肠镜1804人次，检出大肠腺瘤225枚，其中91例行CEA组织化学染色，15例行电镜观察。结果：腺瘤肠镜检出率为12．47％（225／1804），癌变33例，癌变率为14．67％（33／225），其中管状腺瘤癌变4例，绒毛管状腺瘤癌变8例，绒毛状腺瘤癌变21例。有蒂的管状腺瘤异型程度轻、癌变率低、预后好；宽蒂、无蒂的扁平型、凹陷型、绒毛状腺瘤，异形程度重，癌变率高，浸润深，预后差。CEA染色阳性率：腺瘤癌变者93．33％（14／15），绒毛状腺瘤78．95％（15／19），绒管状腺瘤70．50％（12／17），管状腺瘤67．5％（27／40）。电镜观察显示绒毛状腺瘤部分腺上皮细胞突破基底膜向间质伸长，可出现异形细胞，核大核沟深，常染色质丰富核仁明显，癌变者可见淋巴细胞溶解癌细胞膜现象。结论：大肠腺瘤为癌前病变，不同类型的大肠腺瘤其治疗及预后不同。     

嗜铬细胞瘤的临床病理免疫组化及超微结构

[目的]研究66例嗜铬细胞瘤的临床病理、免疫组化及超微结构。[方法]对石蜡切片用ABC法避免疫级化染色，并对增殖细胞核抗原植效（PCNALI）进行计算。对新鲜瘤组织采用3％戊二醛和1％酸固定，超薄切片用醋酸轮和柠檬酸铅双重染色透射电镜观察。[结果]免疫级化染色瘤细胞表达Chromogranin阳性（20／23），NSE阳性（19／23）和synaptophysin阳性（17／23）。8例作了电镜检查在瘤细胞中可见神经内分泌颗粒。［结论］提示PCNALI对恶性嗜铬细胞瘤的诊断具有重要价值。电镜检查对于嗜锭细胞瘤与肾上腺皮质肿瘤的鉴别具有重要意义。     

小细胞肺癌内窥镜、病理学及免疫组织化学研究

 目的 研究218 例肺小细胞癌的纤维支气管镜、临床病理及免疫组织化学特征。方法 分析纤维支气管镜、病理特征并选择80 例作免疫组织化学观察。结果 纤维支气管镜检以不规则结节状隆起物和管腔狭窄最为常见。80 例免疫组织化学染色结果显示： CK69 例、EMA74例、NSE72 例、5-HT56 例呈阳性反应, 表明它们向上皮和神经内分泌方向分化。结论 肺小细胞癌向上皮和神经内分泌方向分化, 表明肺小细胞癌来自多能干细胞。     

Magnetic Resonance Image Manifestations of the Atypical Meningioma

Through retrospective analysis of 13 cases of magnetic resonance image (MRI) manifestations of atypicalmeningiomas confirmed by operation and pathology in the First Affiliated Hospital of Xinxiang MedicalUniversity, the objective of this study was to evaluate the diagnostic value of MRI in order to improve the accuracyrate of preoperative diagnosis. In this retrospective analysis of MRI findings for atypical meningiomas in FirstAffiliated Hospital of Xinxiang Medical University from January to July in 2012, the location, morphologyand tumor signals and other tumor imaging characteristics were covered. In 13 cases of atypical meningiomapatients of this group, most tumors were located at typical sites (10/13), mainly the falx cerebri, parasagittal,convexity, saddle area. Only two cases were at atypical locations, 1 in the cerebellar hemisphere and 1 in a lateralventricle. Most of the tumors showed T1 and T2 isointensity signals, and necrosis, calcification, and peritumoraledema were always featured. DWI showed isointensity in 11 cases (11/13), and hyperintensity in 2. Some 9 caseshad dural tail signs, 12 had accurate positioning (12/13), and 2 were postoperative recurrences. MRI has highvalue in the diagnosis of atypical meningiomas, with important roles in early clinical diagnosis, treatment andprognosis evaluation.     

The Role of Pre-Operative MRI for Prediction of High-Grade Intracranial Meningioma: A Retrospective Study

Objective: High histological grade (WHO grade 2 and 3) intracranial meningiomas have been linked to a greater risk for tumor recurrence and worse clinical outcomes compared to low-grade (WHO grade 1) tumors. Preoperative magnetic resonance imaging (MRI) plays a crucial role in tumor evaluation and allows a better understanding of tumor grading, which could potentially alter clinical outcomes. The present study sought to determine whether preoperative MRI features of intracranial meningiomas can serve as predictors of high-grade tumors. Methods: This retrospective study reviewed 327 consecutive confirmed cases of intracranial meningiomas, among whom 210 (64.2%) had available preoperative MRI studies. Thereafter, imaging features such as intratumoral signal heterogeneity, venous sinus invasion, necrosis or hemorrhage, mass effect, cystic component, bone invasion, hyperostosis, spiculation, heterogeneous tumor enhancement, capsular enhancement, restricted diffusion, brain edema, and unclear tumor-brain interface were obtained and data were analyzed using univariate and multivariate analyses. Results: 249 (76.1%) patients had low-grade (grade I), and 78 (23.9%) had high-grade (grades 2 and 3) intracranial meningioma. The majority of cases were females (274 cases, 83.3%) and most patients were below 60 years of age (mean age, 52.50 ± 11.51 years). The multivariate analysis with Multiple Logistic regression analysis using factors determined to be significant during univariate analysis via a backward stepwise selection method with statistical significance set at 0.05 identified three MRI features including necrosis or hemorrhage (adjusted OR = 2.94, 95% CI: 1.15–7.48, p = 0.024), hyperostosis (adjusted OR = 0.31, 95% CI: 0.12–0.79, p = 0.014), and brain edema (adjusted OR = 2.33, 95% CI: 1.13–4.81, p = 0.022) as significant independent predictors of high-grade meningioma after adjusting for confounders. Conclusions: Our study suggested that certain preoperative MRI features of intracranial meningiomas including necrosis or hemorrhage and brain edema could potentially predict high-grade tumors while hyperostosis is a predictor for low-grade tumors.     

Huge Bilateral Pulmonary and Pleural Metastasis from Intracranial Meningioma: A Case Report and Review of the Literature

Summary A case of recurrent meningioma with atypical features and extracranial metastases is reported. A 34-year-old female was operated in 1996, 2000, and 2002, and frontal parasagital meningioma was extirpated. Histological diagnoses of all the resected tumors were meningotheliomatous meningioma, WHO Grade I. However, 2 years later, the tumor recurred in the frontal scalp and was removed again totally. Histological diagnosis was reported as an atypical meningioma; meningotheliomatous type; WHO Grade II. She received radiation therapy. But the tumor had metastasized to the lung and pleura. Transthoracic tru-cut biopsy was performed from large mass of the left lung. Cytopathology was consistent with malignant meningioma, metastasis from the patient’s known intracranial meningioma. Ki-67 staining index at the primary and metastatic sites of the present cases were 7 and 5%, respectively. We reviewed and discussed the histopathological features and mechanisms of metastasizing meningioma.     

脑原发性淋巴瘤临床病理及免疫组化研究

[目的]收集17例中枢神经系统原发性淋巴瘤 ,对其临床病理特点及免疫组化染色特征进行探讨。[方法]标本采用常规石蜡切片、HE染色及SP法免疫组化染色 ,光镜观察。[结果]17例患者中男性12例 ,女性5例 ;中位年龄50岁。17例中肿瘤位于顶叶5例 ,额叶4例 ,颞叶和基底节区各3例 ,小脑2例。16例肿瘤细胞呈弥漫围绕血管分布 ,仅1例在肿瘤内可见部分滤泡形成。17例肿瘤细胞均为LCA阳性表达 ,其中16例L26阳性 ,1例UCLH1阳性。[结论]PCNSL好发于50岁左右男性患者 ,以顶、额叶多见。镜下见肿瘤细胞多呈弥漫围绕血管分布。免疫组化染色证明肿瘤多为B细胞性淋巴瘤 ,T细胞性淋巴瘤较罕见     

弥漫性大B细胞淋巴瘤临床病理分析

 目的　探讨弥漫性大 B细胞淋巴瘤（DLBCL）的临床病理特征、免疫表型,以提高对DLBCL的诊断水平。方法　对22例DLBCL患者进行回顾性分析,复习组织形态和临床表现,补充完善所有患者CD20、CD3、CD10、bcl-6、MUM-1、Ki-67免疫表型测定,为与其他肿瘤相鉴别,对精原细胞瘤、间变性大细胞性淋巴瘤、母细胞型套细胞淋巴瘤部分病例检测AE1／3、PLAP、CD30、ALK、CD5和CyclinD1。结果　22 例患者均为原发DLBCL,男性14例,女性8例,年龄21～71岁,平均48岁;13例结内,9例结外。生发中心细胞（CGB）型13 例（结内7例,结外6例）,非CGB（non-CGB）型9例（结内6例,结外3例）,结合临床和组织形态学17例可诊断,再结合免疫组织化学22例均可诊断。结论　DLBCL形态学、免疫表型及临床表现有一定的特征性,三者相结合能较准确诊断。     

Sclerosing Meningioma: Clinicopathological Study of Four Cases

Sclerosing meningioma is a distinct histologic subtype of meningioma, however, it is often confused with other tumors, especially malignant tumors. To widen our knowledge of sclerosing meningioma and to help neurosurgeons and neuropathologists diagnose this clinically and pathologically unfamiliar disease entity, we reviewed four such cases, which were originally misdiagnosed. Sclerosing meningiomas were assessed for cellularity, cellular pleomorphism, mitotic activity, brain invasion, and necrosis. Immunohistochemical staining was performed on paraffin-embedded sections using the avidin-biotin-peroxidase complex method. The histologic appearance of the underlying cerebral parenchyma invasion by tumor cells led to a diagnosis of malignant meningioma or to the completely erroneous diagnosis of ganglioglioma. The most conspicuous histologic finding of these four sclerosing meningiomas was extensive collagen deposition, so called 'sclerosis' and an intermingled small population of spindle or round cells with clear cytoplasmic halos, giving a 'fried egg' appearance. However, a typical meningothelial whorl pattern was identified in all cases. Tumor cells exhibited positive immunoreactivity for epithelial membrane antigen and vimentin, but were negative for glial fibrillary acidic protein, p53, S-100, and neuronal markers. Proliferative indices, using Ki-67, ranged from 0% to 4%, and brain invasion was present in three of four tumors. All four patients are doing well with no evidence of tumor recurrence (follow-up duration of 25 months to 12 years). Brain invasion needs to be re-evaluated as a criterion of malignancy in meningioma. Special attention should be paid to the diagnosis of this subtype of meningioma to prevent unnecessary postoperative radiotherapy and to ensure correct therapeutic decision.