脑膜瘤中三种性激素受体的表达及其意义

目的:探讨脑膜瘤中雄激素受体(AR)、孕激素受体(PR)和雌激素受体(ER)的表达及其意义。方法:运用免疫组织化学及组织微阵列方法,对62例脑膜瘤进行分析研究,免疫组织化学采用En-Vision二步法,一抗选用抗AR、PR、ER单克隆抗体。结果:62例脑膜瘤中PR的阳性率为41.9%,脑膜上皮型、过渡型、纤维型、非典型型及间变型脑膜瘤中PR的阳性率分别为81.8%、55.6%(5/9)、30.8%、33.3%(2/6)和00/0;PR的表达与性别无关,62例脑膜瘤中未发现AR、ER的表达。结论:脑膜瘤中存在较高比例的PR表达,未检测到AR、ER的表达,常规检测脑膜瘤中性激素受体的表达,对脑膜瘤术后的抗性激素受体药物治疗具有指导意义。     

肺原发性脑膜瘤1例并文献复习

目的:探讨肺原发性脑膜瘤的临床病理特征、诊断和鉴别诊断、治疗及预后。方法:回顾性分析1例肺原发性脑膜瘤患者的临床资料、组织病理形态、免疫组织化学染色、治疗及随访结果,并回顾相关文献。结果:光镜下肿瘤细胞呈短梭形,细胞呈漩涡状排列,细胞异型性不明显,未见明确核分裂象。免疫组织化学染色结果显示肿瘤细胞胞浆AE1/AE3、CK8/18灶状(+)、EMA(+),S100、SMA、TTF-1、CD34、CD31、PR、ALK、Sy n均(–),Ki-67阳性率约1%。组织学和免疫组织化学染色结果均支持良性脑膜瘤的诊断。结论:肺原发性脑膜瘤十分少见,掌握其临床病理特征对该病的诊断、鉴别诊断、治疗及预后具有重要意义。     

脑膜血管瘤病伴少突胶质细胞瘤临床病理观察

目的探讨脑膜血管瘤病(MA)的临床、影像学和组织学特点及鉴别诊断。方法报告脑膜血管瘤病伴少突胶质细胞瘤1例并复习文献。结果散发性MA发病较年轻,临床表现以癫多见;影像学差异较大,无特异性。本例镜下大部分呈MA的组织学特点,即软脑膜上皮细胞、脑膜血管和血管周梭形纤维母细胞结节状或旋涡状增生,形成边界清楚的皮质内斑块,另见少许少突胶质细胞瘤成分(WHOⅡ级)。免疫组化:梭形细胞vimentin和CD34(+),EMA和CKAE1/AE3(-)。结论 MA是罕见的良性病变,可伴发少突胶质细胞瘤、脑膜瘤等;单纯切除是首选治疗,预后良好。     

免疫组织化学在骨髓活检中的应用

20世纪50年代后期，McFarland和Dameshek将骨髓活检应用于临床诊断，克服了骨髓穿刺时出现“干抽”而无法做涂片进行形态学观察的问题。其对白血病、淋巴增殖性疾病、髓性增殖性疾病及转移性和反应性病变的诊断可提供有价值的信息。骨髓活检免疫组织化学的结果不如涂片．但结合骨髓组织学的优势(如骨髓中细胞成分所占的比例、     

脊索样脑膜瘤:15例报道

目的:探讨脊索样脑膜瘤(chordoid meningioma,CM)的临床、影像及病理特征。方法:回顾性分析15例CM的临床病理特征并复习相关文献。结果:15例CM中女性占多数(女:男=11:4),年龄1 5~7 1岁,平均4 7.4岁。主要发生部位为额顶叶凸面、蝶骨嵴。以头痛、视力模糊、肢体乏力、面部感觉异常和言语含糊等为主要表现就诊。影像学主要表现为典型脑膜瘤特征,如界限清楚、脑膜尾征以及粘液成分引起的高低混杂信号等。组织病理学除表现典型脑膜瘤外,见不同比例(20%~100%)的脊索样成分,即嗜碱性的黏液背景中肿瘤细胞呈条索状、筛网状、假菊型团样或巢团状排列,细胞呈上皮样或胖梭形细胞,胞浆丰富嗜酸性,部分含脂滴样空泡。免疫组织化学及组织化学染色显示Vimentin、EMA、PR及PAS阳性,S-100、CK和D2-40局灶阳性,GFAP阴性,K i-6 7增殖指数1%~1 0%,平均3%。1 3例行全切手术,其中1例术后辅助放疗,另外2例行次全切除。随访时间1~120月不等,结果显示2例肿物次全切除者术后复发,其余均无瘤生存。结论:CM好发于中老年女性。临床症状多样。影像学对具有典型影像特征的脑膜瘤有提示作用,反之易误诊,诊断及鉴别诊断依赖镜下形态和免疫组织化学染色等。肿瘤切除程度与预后密切相关,对于次全切除患者建议术后进一步辅助放疗。     

脑膜血管周细胞瘤临床病理分析

目的：探讨脑膜血管周细胞瘤（hemangio Pericytoma,HPC）的临床病理特点及鉴别诊断。方法：对9例脑膜HPC患者临床病理资料进行回顾性分析和随访15～95个月,并复习相关文献。结果：脑膜HPC常见症状为头痛头昏、肿瘤压迫和颅内高压;CT／MRI检查见肿瘤与脑膜相连,增强扫描明显强化。光镜下肿瘤细胞丰富,核圆形或卵圆形,核仁不明显;间质富含“鹿角状”血管,网状纤维包绕单个瘤细胞。免疫标记瘤细胞CD34局灶阳性,PR阴性,1例EMA局灶弱阳性。7例随访15-95个月,4例术后复发,复发病例中l例术后35月腰椎转移。结论：脑膜HPC是一种少见肿瘤,确诊需依靠病理学检查。脑膜HPC影像学上与脑膜瘤相似,但其生物学行为、病理组织学及预后不同于脑膜瘤,易复发和远处转移,术后需长期随访。     

颅内血管外皮细胞瘤

颅内血管外皮细胞瘤(hemangiopericy-toma,HPC)是一种罕见的颅内血管性肿瘤,发病率低,约占中枢神经系统肿瘤的0.29%～1%[1],占脑肿瘤的1%。1942年Stout和Murray首先报道并将其命名为hemangiopericy-toma[2],以往将其归为脑膜瘤的一种类型,Lolova对肿瘤酶组织化学的研究和Popoff的电镜观察,证实颅内HPC与身体其他部位的HPC完全相同,与脑膜瘤在组织学和生物学行为上均有不同之处[3,4]。后来,Joseph通过检测NF2基因,从分子基因水平证实,HPC与脑膜瘤不同源[3,5]。其来源于脑膜间质的毛细血管Zimmerman细胞,该细胞是紧贴毛细血管网状纤维…     

41例脑膜瘤病人的围术期护理

正脑膜瘤是一种发生在脑膜和脑膜间隙之间的异常衍生物,其主要来自硬膜成纤维细胞和软脑膜细胞,但大多均来自蛛网膜细胞。脑膜瘤在临床中发病率可达2/10万,其占原发性脑肿瘤发病率的38%左右[1],发病率仅次于胶质瘤。临床中女性脑膜瘤的发病率要明显高于男性人群,其与男性发病比例约为2∶1。虽然肿瘤的不断增长,病人大多以头痛、癫痫等作为首发症     

超声引导下细针穿刺组织学检查联合细胞块免疫组织化学与粗针组织学检查在浅表淋巴结病变诊断中的对比研究

目的对比分析超声引导下细针穿刺组织学检查联合细胞块免疫组织化学与粗针组织学检查对于诊断浅表淋巴结疾病的临床应用价值。方法选取淋巴结病变患者75例,超声引导下分别采用25G细针及18G活检针穿刺取材,所获得标本分别送细胞学检查结合细胞块免疫组织化学以及组织学检查结合免疫组织化学检测。对两者的诊断结论并结合随访结果进行回顾性分析及对比。结果本组病例细针穿刺取材成功率为93.3%(70/75),粗针穿刺取材成功率为96.0%(72/75)。70例细针穿刺患者中,64例细胞学检查与细胞块免疫组织化学联合诊断结果与随访结果相符,临床诊断符合率为91.4%(64/70)。72例粗针穿刺患者中,67例组织学检查结合免疫组织化学联合诊断结果与随访结果相符,临床诊断符合率为93.1%(67/72)。两种不同方法检测结果比较,其穿刺取材成功率及临床诊断符合率差异无统计学意义(P0.05)。结论超声引导细针抽吸细胞学检查联合细胞块免疫组织化学诊断浅表淋巴结病变简便实用、安全可靠,与粗针组织学检查的临床诊断符合率无差异。     

脑膜瘤"脑膜尾征"的MRI表现及其病理学基础

目的探讨脑膜瘤“脑膜尾征”的MRI表现、病理学基础和临床意义。方法收集45例具有“脑膜尾征”并经手术及病理证实的脑膜瘤患者为研究对象,术前均行MRI平扫及增强检查,术中与临床神经外科医生合作,在切除脑膜瘤瘤体的同时,切除术前增强MRI图像中“脑膜尾征”相对应的脑膜组织,术后送病理学检查,观察“脑膜尾征”处脑膜组织的病理学改变。结果在获取的45例“脑膜尾征”的组织标本中,37例（82．2％）有脑膜瘤细胞的浸润,光镜下可见多个成团状或巢状肿瘤细胞聚集在纤维结缔组织中;3例（6．7％）光镜下仅见大量的结缔组织反应性增生,未见肿瘤细胞：5例（11．1％）光镜下可见大量红细胞及增生的血管和炎症细胞浸润,未见肿瘤细胞。脑膜尾中有无肿瘤细胞浸润与瘤周水肿和脑膜瘤的良恶性分级相关（P〈0．05）,而与脑膜瘤本身的大小和脑膜尾征的形态无相关性。结论大多数“脑膜尾”组织中有肿瘤细胞浸润,在切除脑膜瘤瘤体的同时,应常规切除“脑膜尾征”对应的脑膜组织。     

卵巢未成熟畸胎瘤继发腹膜黑变病临床病理观察

目的探讨卵巢未成熟畸胎瘤继发腹膜黑变病的临床病理特征。方法对1例腹膜黑变病临床、组织病理学、特殊染色、免疫组化结果进行分析,并复习文献。结果患者女性,30岁。因"胆囊炎、胆石症"腹腔镜下行胆囊切除术。巨检发现胆囊浆膜面黑色斑块。镜下见大量含黑色素细胞,排列成巢状及腺泡状,脱色素后,细胞清晰,胞质透明,核圆形及卵圆形。免疫组化示部分细胞CD68(+),部分细胞NSE、GFAP和S-100(+)。未经任何治疗,随访16个月,无任何症状。结论患者因卵巢未成熟畸胎瘤破裂继发腹膜黑变病。     

卵巢恶性苗勒管混合瘤6例临床病理分析

目的探讨卵巢恶性苗勒管混合瘤的临床病理特点及鉴别诊断。方法复习6例卵巢恶性苗勒管混合瘤患者的临床资料,行常规石蜡切片和免疫组化染色。结果恶性苗勒管混合瘤镜下肿瘤成分复杂,形态多样,由上皮和间叶两种成分构成,相互间有穿插及移行。免疫组化:腺上皮CK(+),间质成分vimentin(+);2例ER(+),1例PR(+);CD34和desmin(-)。结论卵巢恶性苗勒管混合瘤诊断主要依赖组织学形态,临床主要与不成熟畸胎瘤相鉴别。     

CELL SURFACE ANTIGENS OF A MOUSE TESTICULAR TERATOMA : IDENTITICATION OF AN ANTIGEN PHYSICALLY ASSOCIATED WITHH-2 ANTIGENS ON TUMOR CELLS

Rabbit antisera to a mouse testicular teratoma, absorbed with normal mouse tissues, react by immunofluorescence with plasma membrane antigens of a variety of transplantable mouse tumor cells and transformed fibroblast cell lines including Clone 1D, SV-40-3T3, and 3T12. Trypsin treatment of cells of "normal" lines, 3T3 and FR-SV-3T3, uncovers reactivity on these as well. Early passage mouse embryo fibroblast cell cultures do not react even after trypsinization. By cross-absorbtion studies, the anti-teratoma serum appears to react with an antigen common to most tumor cells investigated thus far. When this antigen on Clone 1D cells is "capped," H-2 antigens collect with the teratoma antigens in the cap indicating a physical association between the molecules. Molecules specified by both the H-2D and H-2K regions are bound to the teratoma antigens in the Clone 1D plasma membrane. This antigen is also found in soluble tumor cell fractions where it is believed to be free of H-2. A second cell surface antigen defined by anti-teratoma serum is expressed only by hepatoma and teratoma itself. This second antigen is apparently a secretory product of teratoma cells. A third surface antigen defined by anti-teratoma serum appears to be specific for the teratoma.     

卵巢原发性恶性黑色素瘤1例及文献复习

目的 探讨卵巢原发性恶性黑色素的临床病理特征,及其与卵巢转移性肿瘤的鉴别诊断。方法 对１例原发于卵巢囊性畸胎瘤的恶性黑色素瘤标本,通过光镜及免疫组化等方法进行病理组织学观察。结果 组织学特征为：肿瘤细胞大小不等,形态多样,界限不清,呈透明细胞和／或印戒细胞样;瘤细胞内外可见一些粗大的黑色素颗粒,瘤组织内血管较多,核分裂现象多见,〉１０个／１０ＨＰＦ。免疫组化ＨＭＢ４５、Ｖｉｍｅｎｔｉｎ及Ｓ－１００     

自身免疫性脑炎临床特征初探

目的:探讨自身免疫性脑炎(AE)的临床特征、治疗及预后。方法:对7例AE患者的临床表现、实验室检查、治疗及预后等临床资料进行回顾性分析。结果:7例AE患者中,4例为抗N-甲基-D-天冬氨酸受体(NMDAR)脑炎,其中2例伴畸胎瘤;2例为抗富含亮氨酸胶质瘤失活蛋白1(LGI1)脑炎;1例为抗γ-氨基丁酸B型受体(GABABR)脑炎。以精神行为异常(5/7)、癫痫发作(4/7)、意识清晰度下降(4/7)、面-臂肌张力障碍发作(FBDs)(1/7)、近事记忆力下降(2/7)为主要临床表现。2例颅脑MRI检查异常。2例脑脊液(CSF)抗NMDAR抗体阳性,2例CSF抗LGI1抗体阳性,1例CSF抗GABABR抗体阳性。2例血清抗NMDAR抗体阳性,1例血清抗GABABR抗体阳性。7例经治疗后4例基本恢复,2例遗留癫痫发作(1例伴精神行为异常),复发1例。结论:以急性发作的精神行为异常、癫痫发作及FBDs为主要临床表现的患者要警惕AE可能。AE临床治疗以激素、免疫球蛋白及手术(伴有畸胎瘤患者)治疗为主,早期诊疗多数预后良好。     

Rhabdomyosarcoma in a patient with mosaic Klinefelter syndrome and transformation of immature teratoma

A 27-year-old man was found to have a mediastinal tumour and the histological diagnosis was immature teratoma. Remission was achieved by chemotherapy and total resection. However, he developed anaemia and leukoerythroblastosis after 2 years of remission, and was referred to our hospital. Rhabdomyosarcoma cells were detected in the bone marrow and pleural effusion. Moreover, karyotype analysis of peripheral blood and bone marrow cells revealed mosaic-type Klinefelter syndrome. We diagnosed the case as transformation of teratoma into rhabdomyosarcoma in Klinefelter syndrome. Although intensive chemotherapy was performed, the patient died with meningeal infiltration.     

血清肿瘤标志物检测联合超声检查对卵巢成熟型畸胎瘤诊断的意义

目的探讨血清肿瘤标志物检测联合超声检查在卵巢成熟型畸胎瘤诊断中的临床意义。方法选取我院卵巢成熟型畸胎瘤手术患者422例。分析血清CA199、CA125、CA724、CEA、AFP在该患者中的表达以及超声诊断的符合率。结果（1）422例成熟型畸胎瘤患者中,测定CA199者230例,118例〉27U／ml,阳性率为51．30％（118／230）。测定CA125者364例,79例〉35U／ml,除外56例伴有明确可以引起CA125升高疾病（如早孕、子宫内膜异位症、卵巢囊肿蒂扭转、急性盆腔炎等）的患者,阳性率6．32％（23／364）。测定CA724者63例,2例〉6．9U／ml,阳性率3．17％（2／63）。测定CEA者159例及AFP者142例,所有检测数值均在正常范围。（2）所有患者均行超声检查,其中有323例术前诊断且术后证实卵巢成熟型畸胎瘤,符合率76．54％（323／422）。（3）CA199阳性组畸胎瘤平均直径为（7．92±2．19）cm,大于阴性组[（4．86±1．65）cm],差异有统计学意义（P=0．023）,双侧畸胎瘤CA199阳性率大于单侧CA199阳性率,差异有统计学意义（P=0．003）。结论卵巢成熟型畸胎瘤的直径越大,CA199阳性率越高;双侧肿瘤的阳性率明显高于单侧。推测CA199在卵巢成熟型畸胎瘤的诊断中具有一定的临床意冀,结合超声检查可以提高其术前诊断的准确性。     

Preoperative evaluation of cystic teratoma: What does color Doppler add?

The aim of this prospective study lasting 4 years was to develop a scoring system using clinical parameters, sonographic findings, and transvaginal color and pulsed Doppler impedance values for the preoperative recognition of cystic teratoma. A total of 887 benign and malignant adnexal masses, among which 102 were histologically proved to be cystic teratomas, were evaluated. Using morphological criteria, cystic teratoma was successfully predicted in 95 patients. The sensitivity and specificity of a morphological scoring system were 93.1% and 99.4%, respectively, while positive and negative predictive values were 95.0% and 99.1%. A scoring system using both morphology and vascular assessment demonstrated higher sensitivity and specificity (99.02%, 99.75%). The application of a scoring system combining morphology and vascularity improves the accuracy of diagnosing cystic teratoma and of separating this entity preoperatively from other benign and malignant ovarian conditions. © 1997 John Wiley & Sons, Inc. J Clin Ultrasound 25:309–316, 1997     

Noninvasive Detection of Human-Induced Pluripotent Stem Cell (hiPSC)-Derived Teratoma with an Integrin-Targeting Agent 99mTc-3PRGD2

Purpose

Since their discovery in 2006, induced pluripotent stem cells (iPSCs) have gained increasing interest for tissue regeneration and transplantation therapies. However, teratoma formation after iPSC transplantation is one of the most serious drawbacks that may limit their further clinical application. We investigated here whether human iPSC-derived teratomas could be detected by an integrin-targeting agent ^99mTc-PEG₄-E[PEG₄-c(RGDfK)]₂ (^99mTc-3PRGD2).

Methods

Human-induced pluripotent stem cells (hiPSCs) were generated and characterized. In vitro integrin α_vβ₃ expression levels of hiPSC- and hiPSC-derived teratoma cells were determined by flow cytometry. ^99mTc-3PRGD2 was prepared, and planar gamma imaging and biodistribution studies were carried out in teratoma-bearing severe combined immunodeficient (SCID) mice. Positron emission tomography (PET) imaging of teratomas with 2-deoxy-2-[¹⁸F]fluoro-d-glucose (¹⁸F-FDG) was also performed for comparison. Integrin α_vβ₃ expression in teratoma tissues was determined by immunofluorescence staining.

Results

^99mTc-3PRGD2 showed high (2.82?±?0.21 and 2.69?±?0.73%ID/g at 0.5 and 1 h pi, respectively) and specific (teratoma uptake decreased from 2.69?±?0.73 to 0.53?±?0.26%ID/g after blocking with cold 3PRGD2) uptake in teratoma tissues, and planar gamma imaging demonstrated the feasibility of noninvasively detecting the teratoma formation with ^99mTc-3PRGD2. ¹⁸F-FDG showed low teratoma uptake and thus failed to detect the teratomas. Ex vivo immunofluorescence staining validated the integrin α_vβ₃ expression in the vasculature during teratoma formation.

Conclusion

Gamma imaging with ^99mTc-3PRGD2 is a promising approach for the noninvasive monitoring of tumorigenicity after hiPSCs transplantation.     

单中心卵巢畸胎瘤患者中合并抗N-甲基-D-天冬氨酸受体脑炎的比例调查及临床特征分析

目的 探究卵巢畸胎瘤患者中发生抗N-甲基-D-天冬氨酸受体（NMDAR）脑炎的比例,并将合并抗NMDAR脑炎的卵巢畸胎瘤患者与未合并抗NMDAR脑炎的卵巢畸胎瘤患者的临床特征进行总结对比。方法 收集卵巢畸胎瘤患者的临床资料,将其分为合并抗NMDAR脑炎组与未合并抗NMDAR脑炎组,对其临床特征进行对比分析。结果 共收集到168例卵巢畸胎瘤患者,其中14例（8.3%）合并抗NMDAR脑炎;合并抗NMDAR脑炎的卵巢畸胎瘤患者年龄低于未合并抗NMDAR脑炎的卵巢畸胎瘤患者[（23.8±5.5）岁 vs. （29.8±9.1）岁,P = 0.016]。合并抗NMDAR脑炎的卵巢畸胎瘤患者肿瘤标志物以癌抗原125及血清铁蛋白升高为主,而未合并抗NMDAR脑炎的卵巢畸胎瘤患者肿瘤标志物以糖类抗原199升高为主。合并抗NMDAR脑炎与未合并抗NMDAR脑炎的卵巢畸胎瘤患者的肿瘤组织均可含有神经组织。结论 卵巢畸胎瘤患者中发生抗NDMAR脑炎的比例不低,对于无明显症状的卵巢畸胎瘤患者,可考虑积极行手术治疗,以降低发生抗NMDAR脑炎的风险。