瘤块样脱髓鞘病变脑组织活检临床病理及细胞凋亡特点

目的 对瘤块样脱髓鞘病变（TDL）髓鞘脱失、胶质细胞再生及凋亡等特点进行观察，并对1例Balo病作形态发生学的探讨。方法 对5例经大脑活组织病理检查诊断为TDL的组织切片作苏木素-伊红（HE）、固蓝、Bielschosky、CD68胶质纤维酸性蛋白（GFAP）染色，并对Bcl-2、Bcl-XL、Bad、Bak、Bax、Fas、Fas-L等7种凋亡基因蛋白作免疫组织化学染色及观察。对所有患者进行随访。结果 白质内同时可见散在大小不一的空泡状脱髓鞘病变和带状／片状的髓鞘保留区（1例为典型的同心圆状排列）。脱髓鞘区同时存在星形胶质细胞增生、肥大及异常核分裂象。髓鞘保留区存在明显的胶质细胞增生。脱髓鞘区胶质细胞的促凋亡基因蛋白表达上调而抑制性基因表达下调。结论 在小块活检组织中，空泡状脱髓鞘区和髓鞘保留区同时存在及分裂象的出现，可作为诊断TDL的参考依据。在1例Balo病中，“髓鞘保留区”存在明显的胶质细胞增生。异常有丝分裂及促凋亡基因蛋白表达上调在髓鞘病变中的意义有待进一步阐明。影像诊断中，TDL还应与脑内其他的占位性病变区别开来。

Clinicopathological features of and apoptosis in patients with tumefactive demyelinating lesion: a biopsy study

Objective To observe the characteristics of demyelination,the regeneration and apoptosis of astrocytes in tumefactive demyelinating lesion(TDL),as well as to explore the morphogenesis in one case of Balo disease. Methods The tissue sections were stained with HE, Luxol-fast blue, Bielschosky,CD68,GFAP and such seven apoptosis gene proteins such as Bcl-2,Bcl-XL,Bad,Bak,Bax, Fas,Fas-L were stained immunohistochemically and observed microscopically in 5 TDL diagnosed by histopathologic examination. All the cases were followed up. Results The coexistence of vacuolar demyelination in different sizes and the zones and (or) patches of reserving myelin areas was found. Both areas were scattered in white matter (1 case showing a typical concentration pattern).The proliferation, hypertrophy and abnormal mitosis of the astrocytes in demyelinating areas and the obvious proliferation of astrocytes in reserving myelin areas were observed. In demyelinating areas, the expression of genes promoting apoptosis increased,while the suppressive genes decreased. Conclusions In smaller biopsy samples,the coexistence of the vacuolar-like demyelinating areas and the reserving myelin areas and the presence of abnormal mitosis are of diagnostic value. In the case of Balo disease,astrocyte proliferation is found in the reserving myelin areas. Significance of the abnormal mitosis and the increase of the expression of promoting apoptosis genes should be clarified further in TDL. In imaging diagnosis, TDL should be distinguished from other occupation lesion in the brain.