脊髓胶质母细胞瘤的特点及诊治

发布时间：2018-01-20 16:05

本文关键词： 脊髓胶质母细胞瘤影像学分子病理综合治疗　出处：《浙江大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:通过分析回顾脊髓胶质母细胞瘤的临床特点,影像学特点,病理学特点,诊断及治疗,对其讨论总结,提高对此类少见疾病的认识。方法:收集并分析浙江大学医学院附属第二医院2012年4月至2016年5月经病理证实的5例(M=2,F=3)脊髓胶质母细胞瘤病例的临床资料,对其临床表现一般情况,影像学核磁共振特征,病理特征及治疗经过进行分析,结合文献复习,总结脊髓胶质母细胞瘤的诊断与治疗要点。结果:5例患者平均年龄为41.2岁,男2例,女3例。病程从11天至3年不等。首发症状不一,表现为肌力减退、感觉异常、进行性瘫痪及大小便障碍。其胸椎或颈椎核磁共振成像(MRI)中,T1表现为等或略长信号,T2均表现为高信号,增强后有不同程度强化。5例患者均作了分子病理检测,都为IDH1野生型(5/5),1例为PTEN阳性(1/5),3例患者的P53表达增加(3/5),2例患者EGFR阳性(2/5),3例患者发生MGMT甲基化(3/5)。主要治疗方式是手术联合放化疗的综合治疗,1例部分切除,其他4例均行大部分切除,其中1例采用荧光素钠技术。1例行STUPP方案化疗,三例放疗,还有一例截止随访日未后续治疗。2例已死亡,生存时间分别为208天和330天。结论:1.脊髓胶质母细胞瘤一经发现应尽早手术,术中辅助运用荧光素钠及神经电生理监测等技术可提高手术安全性,在安全的前提下尽可能切除肿瘤,缓解症状,提高术后生活质量。2.脊髓胶质母细胞瘤在影像学上虽无明显特异性,但核磁共振的检查有助于明确肿瘤发生的部位、累及范围、有无坏死等情况,并且对手术后的长期随访有重要价值。3.脊髓胶质母细胞瘤的分子学检查有助于进一步确定胶质瘤的等级与侵袭性。
[Abstract]:Objective: to review the clinical features, imaging features, pathological features, diagnosis and treatment of glioblastoma of the spinal cord. Methods: to collect and analyze 5 cases of pathologically proved MV2 from April 2012 to 2016 in the second affiliated Hospital of Zhejiang University Medical College. The clinical data of patients with glioblastoma of spinal cord were analyzed. The general clinical manifestations, MRI features, pathological features and treatment were analyzed, and the literature was reviewed. Results the mean age of 5 cases of glioblastoma of spinal cord was 41.2 years old, 2 males and 3 females. The course of disease ranged from 11 days to 3 years. The symptoms were hypotony, abnormal sensation, progressive paralysis and dysuria. In MRI of thoracic or cervical MRI, T _ 1 and T _ 2 showed iso-or slightly longer signal intensity and high signal intensity. Molecular pathological examination was performed in 5 patients with different degree of enhancement after enhancement. All of them were IDH1 wild-type 5 / 5 / 5. One case was PTEN positive 1 / 5). P53 expression increased by 3 / 5 / 5 in 3 patients and 2 / 5 of EGFR positive in 2 patients. MGMT methylation occurred in 3 cases (3 / 5). The main treatment was surgery combined with radiotherapy and chemotherapy in 1 case with partial resection and the other 4 cases with major resection. One patient received STUPP regimen chemotherapy with sodium fluorescein technique, three patients received radiotherapy, and one patient died without follow-up treatment at the end of the follow-up day. The survival time was 208 days and 330 days respectively. Conclusion 1. Once the glioblastoma of the spinal cord is discovered, it should be operated as soon as possible, and the safety of the operation can be improved by using fluorescein sodium and electrophysiologic monitoring during the operation. In the premise of safety, as far as possible to remove the tumor, alleviate symptoms, improve the quality of life after surgery .2.The spinal cord glioblastoma in imaging although there is no obvious specificity. However, MRI is helpful to identify the location of the tumor, the extent of the involvement, whether there is necrosis or not. The molecular examination of glioblastoma of spinal cord is helpful to determine the grade and invasiveness of glioma.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R739.42

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