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.     

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.     

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％。     

细胞增殖特性与良性脑膜瘤复发的关系

目的 :探索良性脑膜瘤的复发与肿瘤细胞增殖能力的关系 ,并寻找能预测其复发的指标。　方法 :对 1 5例复发的良性脑膜瘤和 2 2例非复发的良性脑膜瘤共 4 9份标本分别进行增殖细胞核抗原 (PCNA)和Ki 6 7的免疫组化染色 ,计数阳性细胞数的比率即标记指数 (LI) ,比较各组间的PCNALI和Ki 6 7LI。　结果 :复发的良性脑膜瘤的PCNALI和Ki 6 7LI均显著高于未复发组 (P <0 .0 5 ) ;复发组中同一患者前后两次手术标本的PCNALI和Ki 6 7LI均无显著差异 (P >0 .0 5 )。　结论 :复发的良性脑膜瘤的细胞增殖性高于未复发组 ,当PCNALI>2 .0 %时 ,提示肿瘤有复发倾向。良性脑膜瘤复发后其增殖特性无明显改变     

跨矢状窦脑膜瘤术中矢状窦的处理

目的总结跨矢状窦脑膜瘤术中矢状窦的处理方法.方法对26例跨矢状窦脑膜瘤及受累矢状窦进行切除,依具体情况重建或不重建矢状窦.结果该组病人无手术死亡,手术后均未加重原有神经功能障碍,无脑血液回流障碍,7例重建矢状窦者未发现有矢状窦内血栓形成.结论矢状窦旁脑膜瘤的治疗除肿瘤切除外,对受累上矢状窦处理是否彻底对预防术后复发是至关重要的.对受累矢状窦应按具体情况按一定的原则进行积极处理.     

鞍结节脑膜瘤的显微外科手术治疗

目的探讨和评价鞍结节脑膜瘤的临床和影像学特点,以及显微外科技术和手术效果.方法回顾性分析本院1985年至2002年手术治疗的鞍结节脑膜瘤41例,分析其临床和影像学表现的特点.根据CT和MR的表现,将其分为大、中、小3型,采用4种不同的手术入路,比较全切除率、手术结果和并发症发生情况.结果鞍结节脑膜瘤的临床特点是早期出现单侧和双侧视力下降,视野改变不典型.MRI特点为明亮均一的增强,肿瘤中心在鞍上,伴基底硬膜尾征,蝶鞍不扩大.肿瘤的全切除率与肿瘤大小有关,中、小型肿瘤全切除率较高.眶上匙孔入路、翼点入路和眶颧入路显露满意和手术效果好,明显优于单侧额下入路.结论鞍结节脑膜瘤早期出现视力下降,以中、小型肿瘤为主.大多数鞍结节脑膜瘤可以完全及安全地切除,小、中型肿瘤宜采用眶上匙孔入路,中、大型肿瘤宜采用翼点侧裂入路,大型肿瘤宜采用眶颧入路切除肿瘤.