影响脑膜瘤术后复发的影像相关因素分析

目的：探讨脑膜瘤切除术后复发的影像相关因素。方法：对20例复发性和98例非复发性脑膜瘤的临床资料、CT、MRI影像进行了对比分析。结果：蕈形及结节形者肿瘤复发率显著高于圆形者（P〈0.01）;中度和重度水肿组复发率显著高于无水肿和轻度水肿组（P〈0.05）;无钙化肿瘤复发率显著高于有钙化肿瘤（P〈0.01）;骨质溶解肿瘤复发率显著高于骨质增生肿瘤（P〈0.01）;有肿瘤内坏死复发率显著高于无肿瘤内坏死肿瘤（P〈0.01）;非均一强化肿瘤复发率显著高于有均一强化肿瘤（P〈0.01）。结论：CT、MRI表现为蕈形及结节形者、严重瘤周水肿、无钙化、周围骨质溶解、肿瘤内坏死及肿瘤非均一强化者具有较高的术后复发率。复发率的高低顺序依次为周围骨质溶解、肿瘤内坏死、蕈形及结节形者、肿瘤非均一强化、无钙化、严重瘤周水肿。其中有周围骨质溶解者复发率远远高于其它（P〈0.01）。     

脑膜瘤微坏死与纤溶酶原激活抑制因子及预后的关系

目的探讨脑膜瘤微坏死与纤溶酶原激活抑制因子-1(PAI-1)和预后的关系.方法采用ABC免疫组化方法检测90例脑膜瘤组织中PAI-1表达,分析其与临床病理因素之间的关系.结果脑膜瘤微坏死发生率与PAI-1表达及恶性程度呈正相关(pearson列联系数分别为0.48和0.61,(P＜0.01);微坏死组脑膜瘤PAI-1表达阳性率85.2%(23/27),术后3年复发率40.7%,分别显著高于无微坏死组的9.5%(6/63)(P＜0.01)和 6.3%(P＜0.01);微坏死组脑膜瘤5年生存率66.7%明显低于无微坏死组的95.2%(P＜0.01).结论PAI-1可能是脑膜瘤发生微坏死的重要因子,脑膜瘤微坏死对判定恶性程度和预后有重要参考价值.     

脑膜瘤的病理学表现与瘤周脑水肿

为了解脑膜瘤的病理学改变与瘤周脑水肿的关系，我们对１３２例脑膜瘤病人的病理切片及２１例电镜检查结果进行了分析。结果发现：合体型、间变型及血管型脑膜瘤易伴重度瘤周水肿。瘤周水肿明显者，病理见肿瘤增殖活跃的表现。肉瘤型、间变型均见于中重度水肿组，非典型型重度水肿者显著高于良性型。若肿瘤血管成分增多，无砂粒体，可见血管外皮细胞易伴瘤周水肿。超微结构见水肿明显者，细胞核增大，核膜溶解，细胞内及细胞外水肿，线粒体溶解，粗面内质网扩张，溶酶体增多。中重度水肿者并可见分泌一排泄现象。     

胸腺上皮源性肿瘤的WHO组织学分型和CT征象的相关性

背景与目的:胸腺上皮肿瘤的生物学和大体形态学的特征多样化,本文旨在探讨根据1999年WHO组织学分型的各亚型胸腺上皮源性肿瘤的CT征象。方法:对经病理检查证实的94例胸腺上皮源性肿瘤患者螺旋CT征象进行回顾性分析,其中包括A型7例,AB型24例,B1型16例,B2型13例,B3型16例,C型18例。结果:在本组94例患者病灶中,A、AB型的长短径明显小于C型(P<0.05);所有A型肿瘤均表现为轮廓光滑,A→C型出现率逐渐下降,A、AB、B1型更常呈轮廓光滑(P<0.05),B3、C型更常呈轮廓不规则(P<0.05);A型瘤内的坏死灶较其他亚型少见(P<0.001);B2、B3、C型肿瘤较A、AB、B1型的瘤灶内更常见多发钙化灶(P<0.05);瘤灶均匀强化更常见于A、AB、B1、B2型(P<0.001);B3、C型瘤灶浸润纵隔脂肪的发生率明显高于其他亚型(P<0.05)。结论:尽管各亚型肿瘤的CT征象存在一定的重叠,小肿瘤、轮廓光滑、类圆形、密度均匀(无钙化、坏死灶)、均匀强化高度提示A型肿瘤,大肿瘤、轮廓不规则、瘤内出现坏死灶、多发钙化、不均匀强化、浸润纵隔脂肪、浸润大血管等高度提示B3、C型肿瘤。     

乳腺癌术后局部复发因素的临床分析

目的探讨乳腺癌术后局部复发的影响因素.方法自1997年1月至2001年1月我院共收治乳腺癌435例.回顾分析术后局部复发的肿瘤自身因素和治疗因素.结果 3年复发率6.4%(26/435),总复发率7.0%(29/435).肿瘤自身因素中,患者年龄、是否绝经、病理类型、激素受体情况、原发肿瘤大小和腋窝淋巴结转移数目是术后局部复发的主要影响因素,其中年龄≤35岁、36～59岁和≥60岁者局部复发率分别为8.1%、6.4%和5.8%(P<0.05);绝经前和绝经后患者局部复发率分别为8.8%和3.5%(P<0.05);各病理类型的局部复发率分别为:原位癌0,早期浸润癌2.0%,浸润性特异型癌4.0%,浸润性非特异型癌8.0%(P<0.05).原发肿瘤T1 T2局部复发率为4.4%,T3 T4为14.5%(P<0.01);腋下淋巴结N0局部复发率为3.0%,N1 8.3%,N2 13.0%(P<0.05);而患者性别和是否有肿瘤家族史对术后局部复发无显著影响.治疗因素中,术后辅助放疗对减少局部复发有一定作用(术后辅助放疗者局部复发率3.0%,未行术后放疗者13.0%,P<0.01);而保乳术后局部复发率(14.0%)高于根治术(3.0%)和改良根治术(7.0%,P<0.05).结论早期诊断、早期治疗是减少乳腺癌复发转移的有效途径,加强辅助治疗可以减少和延缓术后局部复发.     

CT在甲状腺滤泡性结节病变诊断和鉴别诊断中的价值

[目的]探讨CT在甲状腺滤泡性结节病变诊断和鉴别诊断中的价值.[方法]搜集经病理证实的122例135枚甲状腺滤泡性结节病变的CT资料,其中包括92例105枚腺瘤性甲状腺肿(ANG),17例17枚腺瘤(FA),13例13枚滤泡细胞癌(FC).分别对ANG与FA、ANG和FA (ANG-FA)与FC在病变形态、平扫密度、强化程度、增强后边界、坏死及钙化状态进行统计分析,并对ANG-FA与FC的环状钙化进行分析.[结果]平扫密度在ANG和FA诊断中具有统计学差异(P＜0.05),形态、强化程度、增强后边界及环状钙化在ANG-FA和FC间具有统计学差异(P＜0.05),而病变强化程度、增强后边界、坏死、钙化在ANG与FA诊断中无统计学差异(P＞0.05),病变平扫密度、坏死、钙化状态在ANG-FA与FC组中无统计学差异(P＞0.05).[结论] CT在滤泡性结节病变的诊断中具有重要价值,平扫密度均匀倾向于FA的诊断,强化程度高于周围甲状腺有助于ANG或FA的诊断,而形态不规则、强化程度低于周围甲状腺、增强后边界较平扫清晰及环状钙化有助于FC的诊断.     

脑膜瘤术后复发再次手术治疗九例

目的 探讨影响脑膜瘤复发的临床因素,以早预防和控制脑膜瘤复发.方法 回顾10年来收治的复发脑膜瘤患者9例.分析其临床因素(如临床表现、影像学表现、手术切除程度、肿瘤大小等)与脑膜瘤复发的关系.结果 肿瘤大小、瘤周水肿、手术切除程度(与窦粘连部分残留)与脑膜瘤复发有明显关系.结论 对有脑浸润或者瘤周脑水肿的脑膜肿瘤患者应适当增大手术切除范围,受侵蚀的骨质应尽量切除,以降低复发率.     

脑膜瘤术后复发再次手术治疗九例

目的 探讨影响脑膜瘤复发的临床因素,以早预防和控制脑膜瘤复发.方法 回顾10年来收治的复发脑膜瘤患者9例.分析其临床因素(如临床表现、影像学表现、手术切除程度、肿瘤大小等)与脑膜瘤复发的关系.结果 肿瘤大小、瘤周水肿、手术切除程度(与窦粘连部分残留)与脑膜瘤复发有明显关系.结论 对有脑浸润或者瘤周脑水肿的脑膜肿瘤患者应适当增大手术切除范围,受侵蚀的骨质应尽量切除,以降低复发率.     

脑膜瘤术后复发再次手术治疗九例

目的 探讨影响脑膜瘤复发的临床因素,以早预防和控制脑膜瘤复发.方法 回顾10年来收治的复发脑膜瘤患者9例.分析其临床因素(如临床表现、影像学表现、手术切除程度、肿瘤大小等)与脑膜瘤复发的关系.结果 肿瘤大小、瘤周水肿、手术切除程度(与窦粘连部分残留)与脑膜瘤复发有明显关系.结论 对有脑浸润或者瘤周脑水肿的脑膜肿瘤患者应适当增大手术切除范围,受侵蚀的骨质应尽量切除,以降低复发率.     

脑膜瘤术后复发再次手术治疗九例

目的 探讨影响脑膜瘤复发的临床因素,以早预防和控制脑膜瘤复发.方法 回顾10年来收治的复发脑膜瘤患者9例.分析其临床因素(如临床表现、影像学表现、手术切除程度、肿瘤大小等)与脑膜瘤复发的关系.结果 肿瘤大小、瘤周水肿、手术切除程度(与窦粘连部分残留)与脑膜瘤复发有明显关系.结论 对有脑浸润或者瘤周脑水肿的脑膜肿瘤患者应适当增大手术切除范围,受侵蚀的骨质应尽量切除,以降低复发率.     

脑膜瘤复发的多因素研究

目的探讨诸多临床因素和影像学特征对脑膜瘤复发的影响。以便能有效地早期预防和控制脑膜瘤复发，改善其预后。方法回顾1993～1997年武汉大学中南医院神经外科经手术治疗脑膜瘤患者145例，对其临床诊治过程和影像学资料进行回顾性分析，发现其中资料齐全的有83例，分析其临床因素如性别、年龄、手术切除程度、组织学类型和影像学特征如瘤周水肿、肿瘤形状、肿瘤大小、骨质改变、肿瘤部位、钙化、瘤周边界、CT增强形态。应用SPSS11．07软件，进行单因素分析和多因素分析。多因素分析应用二值多元logic回归模型，以诸多临床因素和影像学特征作为自变量，复发与否作为因变量。结果经单因素分析显示：肿瘤形状、肿瘤大小、瘤周水肿、组织学类型，手术切除程度、肿瘤部位和CT增强形态与脑膜瘤复发有明显关系。多因素分析显示：肿瘤形状、肿瘤大小、肿瘤部位、瘤周水肿、组织学类型、手术切除程度、CT增强形态是影响恼膜瘤复发的主要因素。其它囟素在单因素分析及多因素分析中均显示对脑膜瘤复发无明显影响。结论脑膜瘤手术切除程度、组织学类型和CT扫描增强对脑膜瘤复发有明显影响。可作为预测脑膜瘤复发的显著危险因子和标准。     

Histopathological features to define atypical meningioma: What does really matter for prognosis?

Atypical meningiomas are diagnosed in the presence of: (1) three or more of the following minor atypical criteria: increased cellularity, small cells with a high nuclear/cytoplasmic ratio, prominent nucleoli, sheeting, and foci of spontaneous or geographic necrosis; (2) mitotic count?≥?4 mitoses per 10 HPF (high mitotic index); (3) brain invasion. The 5-year disease-free survival (DFS) is around 50%. Due to their heterogeneous behavior, the post-surgical treatment of atypical meningiomas is controversial. This study investigated the ability of histopathological features to predict recurrence risk of atypical meningiomas. Meningiomas classified as atypical only on minor atypical criteria had low recurrence risk. Brain invasion, high mitotic index and sheeting were significantly associated with shorter disease-free survival (DFS) (P?=?0.001; P?=?0.01; P?=?0.01). The presence of brain invasion and the co-presence of sheeting and high mitotic index had the highest ability to identify recurring meningiomas (P?=?0.0001) (sensitivity: 90.9%; specificity: 86.7%). Our results suggest reconsideration of classification of meningiomas as atypical based only on minor atypical criteria. The presence of brain invasion and the co-occurrence of sheeting and high mitotic count may be useful to identify high risk cases, which may benefit from adjuvant treatments.     

56例瘤周脑水肿与脑膜瘤增殖及术后复发的临床意义

目的:探讨瘤周脑水肿(Peritumor brain edema,PTBE)程度与脑膜瘤细胞增殖及术后复发之间的关系.方法:分析56例Simpson Ⅰ～Ⅱ级切除的脑膜瘤患者,按术前瘤周脑水肿程度分为无、轻和重度水肿组,术后测定各组肿瘤增殖细胞核抗原(Proliferating cell nuclear antigen,PCNA)表达水平,分析瘤周水肿程度、PCNA标记指数(PCNALI)及术后复发之间的关系.结果:56例患者中5例复发,复发率为8.93%,其中轻度水肿1例,重度水肿4例.36例可在术前CT或MRl观察到瘤周脑水肿,3组的PCNA LI分别为(0.99±0.16)%,(2.87±0.36)%,(3.89±0.35)%,统计分析表明水肿程度与PCNA LI及复发率之间有较好的相关性.结论:瘤周脑水肿程度与脑膜瘤的增殖和术后复发密切相关,是预测肿瘤复发的一个良好指标.     

Secretory meningiomas: A benign subgroup causing life-threatening complications

While meningiomas are known as slow-growing extra-cerebral neoplasms, the subgroup of secretory meningiomas with histologically benign characteristics tend to cause disproportional peritumoral edema, frequently leading to severe medical and neurological complications in postoperative management. Among 1,484 meningiomas that were resected at our institution between 1990 and 2007, 44 (3%) patients were found to have the histological diagnosis of a secretory meningioma. The clinical course, radiological appearance, and histopathological features were retrospectively analyzed to examine the specifics of these benign lesions. Meningiomas were located at the convexity (n = 14), the cranial base (18), and the sphenoid ridge (12). A severe, nearly hemispheric perifocal edema disproportional to tumor size was seen on preoperative MR imaging in 18 (41%) patients. Following surgical resection, the postoperative course was uneventful in 29 patients. In 15 patients, severe peritumoral edema continued or even increased on postoperative CT imaging. Six patients showed midline shift and clinical worsening necessitating respirator-assisted ventilation and intracranial pressure monitoring. An association between the extent of brain edema and number of periodic acid Schiff–positive pseudopsammomas was found (p < 0.02). Further, the size of the edema correlated with the number of immunohistochemically detected cells expressing carcinoembryonic antigen (CEA) and cytokeratin (CK) (p < 0.01). Mean MIB-1 (Ki-67 antigen) proliferation index was 3.0% (range, 0%–17%) and did not correlate with edema or tumor recurrence. Secretory meningiomas are frequently associated with severe peritumoral edema. The extent of edema correlates with immunohistochemically detected expression of CEA and CK. Extended perifocal edema in meningiomas is an unusual finding and should alert the neurosurgeon that surgery may aggravate edema excessively, leading to a life-threatening postoperative situation.     

Scoring radiologic characteristics to predict proliferative potential in meningiomas

We investigated the feasibility of using radiologic characteristics to predict the proliferative potential in meningiomas. Our statistical analysis revealed that the presence of peritumoral edema, an ambiguous brain–tumor border, and irregular tumor shape were significantly correlated with a higher MIB-1 staining index (SI) value. We developed the following scoring system for specific features in each tumor: peritumoral edema (tumor with edema = 1, tumor without edema = 0); brain–tumor border (tumor with any ambiguous border = 1, tumor circumscribed by a distinct rim = 0); and tumor shape (tumor with irregular shape = 1, tumor with smooth shape = 0). Using Spearman's correlation coefficient analysis, we found a significant correlation (P < 0.005) between total score calculated for each patient and SI value. Our findings suggest that the proliferative potential of meningiomas can be predicted using a less invasive preoperative examination focusing on the presence of peritumoral edema, ambiguous brain–tumor border, and irregular tumor shape.     

Necrosis is a consistent factor to recurrence of meningiomas: should it be a stand-alone grading criterion for grade II meningioma?

The purpose of this study was to evaluate spontaneous necrosis as a possible isolated factor for progression and recurrence in grade I meningiomas classified according to the current World Health Organization (WHO) classification. Meningiomas are the most frequently reported primary intracranial tumours, accounting for more than 35%. The 2016 WHO classification of central nervous system tumors stratifies meningiomas in grades I (benign), II (atypical), and III (malignant), according to histopathological aspects and the risk of progression or recurrence. Among 110 patients with intracranial meningiomas, 70 were WHO grade I meningiomas with no findings of atypia (G1WON), 15 were WHO grade I with necrosis (G1WN), 21 were WHO grade II (G2), and 4 were WHO grade III (G3). The mean follow-up was 5.9?±?0.2 years. High performance scale (KPS?≥?80) was different (p?<?0.001) between WHO grade I meningiomas without (81.4%) and with (60%) necrosis. The 5-year mortality rate was 1.4, 6.7 and 5.9% for G1WON, G1WN and G2, respectively, with significant difference (p?=?0.011) related to the presence of necrosis. The risk of recurrence was 3.7 times higher in G1WN than in G1WON (p?=?0.017), and 4.2 times in G2 (p?=?0.010). Progression-free survival (PFS) was clearly higher in patients with G1WON compared to G1WN and G2 (p?=?0.002 and p?<?0.001, respectively). There was no significant difference in PFS between G1WN and G2 (p?=?0.692). Retreatment was also superior in meningioma with necrosis. Our findings provide clear statistical data to consider that patients with benign meningiomas and histologic findings of spontaneous necrosis are at increased risk of progression and recurrence compared to those with benign lesion without atypical features. Statistical analysis curves also suggest that these lesions behave more similarly to those currently classified as WHO grade II meningioma.     

脑膜瘤p53蛋白的表达及肿瘤血管形成的临床病理研究

目的　探讨p5 3在脑膜瘤中的表达及其对肿瘤血管形成和临床病理行为的影响。方法　应用免疫组织化学SP法检测 5 2例脑膜瘤组织中p5 3、第VⅢ因子相关抗原 (FVⅢRAg)的表达情况 ,并结合临床、影像和病理参数进行综合分析。结果　p5 3的表达和微血管密度 (MVD)与患者病情、脑膜瘤病理分级、侵袭性、瘤周水肿显著相关 (P <0 0 5 ) ;p5 3的表达与MVD呈正相关 (r =0 618,P<0 0 1)。结论　p5 3在肿瘤血管形成、恶性转化和浸润、瘤周水肿等方面起着重要作用。检测脑膜瘤p5 3的表达和MVD对进一步了解脑膜瘤生物学行为、临床表现和判断预后有一定价值。     

脑膜瘤复发的多因素研究(英文)

目的探讨诸多临床因素和影像学特征对脑膜瘤复发的影响。以便能有效地早期预防和控制脑膜瘤复发,改善其预后。方法回顾1993～1997年武汉大学中南医院神经外科经手术治疗脑膜瘤患者145例,对其临床诊治过程和影像学资料进行回顾性分析,发现其中资料齐全的有83例,分析其临床因素如性别、年龄、手术切除程度、组织学类型和影像学特征如瘤周水肿、肿瘤形状、肿瘤大小、骨质改变、肿瘤部位、钙化、瘤周边界、CT 增强形态。应用 SPSS 11.07软件,进行单因素分析和多因素分析。多因素分析应用二值多元 logic 回归模型,以诸多临床因素和影像学特征作为自变量,复发与否作为因变量。结果经单因素分析显示:肿瘤形状、肿瘤大小、瘤周水肿、组织学类型,手术切除程度、肿瘤部位和 CT 增强形态与脑膜瘤复发有明显关系。多因素分析显示:肿瘤形状、肿瘤大小、肿瘤部位、瘤周水肿、组织学类型、手术切除程度、CT 增强形态是影响脑膜瘤复发的主要因素。其它因素在单因素分析及多因素分析中均显示对脑膜瘤复发无明显影响。结论脑膜瘤手术切除程度、组织学类型和 CT 扫描增强对脑膜瘤复发有明显影响。可作为预测脑膜瘤复发的显著危险因子和标准。     

脑膜瘤复发的影像学、临床因素探讨

目的:分析影像学特征和临床因素对脑膜瘤复发的影响.方法:对1992年1月～2000年1月本院神经外科经手术治疗脑膜瘤患者166例进行回顾性分析,应用SPSS11.07通过卡方检验进行单因素分析,应用二值多元Logic回归模型,以影像学和临床指标作为自变量,复发与否作为因变量作多因素分析.结果:单因素分析:肿瘤部位、肿瘤大小、肿瘤形状、瘤周水肿、组织学类型,手术切除程度、CT增强形态与脑膜瘤复发有明显关系,有显著性差异.多因素分析:肿瘤部位、肿瘤形状、手术切除程度、组织学类型、CT增强形态是影响脑膜瘤复发的主要因素,有显著性差异.结论:肿瘤部位、肿瘤形状、手术切除程度、组织学类型和CT扫描增强对脑膜瘤复发有明显影响.     

Recurrence and regrowth of benign meningiomas

The World Health Organization (WHO) grading system for meningioma is helpful for predicting aggressive subtypes. However, even benign meningiomas sometimes show relatively rapid growth and may recur after total removal. We attempted to find histopathological features that would be valuable for predicting recurrence or regrowth of WHO grade I meningiomas. We investigated 135 benign meningiomas, of which 120 were totally removed (Simpson’s grade I–III). The median follow-up period was 9.7 years (1–21 years). The recurrence rate in the patients with total removal was 7.5% at 10 years and 9.3% at 20 years. The univariate analysis revealed that MIB-1 index (≥2%), existence of mitosis, absence of calcification, and paucity of fibrosis significantly correlated with recurrence. On the other hand, the histological features of sheet-like growth, prominent nucleoli, and necrosis did not correlate with recurrence, because they were relatively rare in grade I tumors. Multivariate analysis revealed that high MIB-1 index and absence of calcification significantly correlated with recurrence. The patients with recurrent or residual tumors did not always receive adjuvant treatment. Including subtotally treated tumors, the retreatment rate was 9.8% at 10 years and 25.6% at 20 years. MIB-1 index and Simpson’s grade significantly correlated with retreatment in both univariate and multivariate analyses.