中枢神经细胞瘤的特性、治疗策略及与脑室外神经细胞瘤的关系的研究

发布时间：2018-05-17 20:26

本文选题：中枢神经细胞瘤 + 脑室内肿瘤　；参考：《华中科技大学》2015年博士论文

【摘要】：目的：对比脑室内其他病理类型的肿瘤,研究中枢神经细胞瘤的临床、影像学及病理学的特点,并探讨其生物学行为。材料与方法：回顾性分析我院自2008年1月至2014年7月行手术治疗并诊断的31例脑室内中枢神经细胞瘤患者及同期诊治的46例侧脑室内的其他病理类型肿瘤患者(25例室管膜瘤、7例少突胶质细胞瘤、7例室管膜下瘤、5例弥漫性星形细胞瘤及2例室管膜下巨细胞型星形细胞瘤)的临床、影像学、病理学、免疫组织化学等相关资料(包括3例中枢神经细胞瘤患者的电镜检查资料),对比脑室内其他病理类型的肿瘤,分析中枢神经细胞瘤的临床相关特点及生物学行为。结果：相比于脑室内其他病理类型的肿瘤,中枢神经细胞瘤主要发生于30岁左右的青年人(p=0.023),男性稍多。在临床上中枢神经细胞瘤多表现出因阻塞性脑积水导致的颅内压增高的症状(p=0.004),且症状大多数在6个月以内(p=0.373),容易合并脑积水(p=0.006)及视神经乳头水肿(p=0.045)。影像学上中枢神经细胞瘤多位于侧脑室额角及室间孔区(p=0.001),边界清楚、不侵及肿瘤周边的结构组织(p0.05),并容易合并钙化、囊变及血管流空影(p0.05)。组织病理学上中枢神经细胞瘤是由来源相同的一致大小的较密集圆形的小的瘤细胞和位于无核区成片的纤维岛(神经毡)组成,非典型的组织病理学如核异型、血管增生及坏死在中枢神经细胞瘤中少见；免疫组织化学表现为神经突触素(Syn)、神经元特异性核蛋白(NeuN)及神经特异性烯醇化酶(NSE)阳性,并且细胞增殖相关的核抗原Ki-67指数较低,平均为2.37%。31例中枢神经细胞瘤中的3例在光镜下表现出非典型的组织病理学特点包括核异型及血管增生,3例氢质子磁共振波普成像表现出显著的胆碱(Cho)峰及降低的N-乙酰天冬氨酸(NAA)峰,3例电镜结果显示肿瘤细胞胞质内有神经分泌颗粒,并形成非典型突触结构及突触内含有大量清亮的囊泡及微管结构。结论：与脑室内其他病理类型的肿瘤相比,中枢神经细胞瘤具有典型的临床、影像学、组织病理学、免疫组织化学及电镜学的特点,依据这些特点可建立准确的临床诊断,中枢神经细胞瘤主要向神经元分化并大多数具有良性的生物学行为,极少数出现非典型改变或远处转移。目的：探讨中枢神经细胞瘤的治疗策略。材料与方法：回顾性分析自2008年1月至2014年7月于我院行手术治疗并确诊的31例脑室内中枢神经细胞瘤的临床、手术及手术后的随访资料。应用相关的统计学方法比较经皮层及经胼胝体两种手术方式在治疗中枢神经细胞瘤中的手术切除程度、术后并发症及临床结局的差异,并分析影响中枢神经细胞瘤复发的相关危险因素,进一步探讨中枢神经细胞瘤的治疗策略。结果：31例中枢神经细胞瘤患者均行显微手术治疗,1例于术后1个月内死亡,余30例患者中有16例辅助放射治疗,1例同步辅助口服替莫唑胺化疗；30例患者随访中有9例复发,其中6例行r刀治疗,3例再次行开颅肿瘤显微切除术,随访期间未见再次复发,随访中5例患者的KPS评分70分。31例中枢神经细胞瘤的手术切除程度、术后并发症及临床结局在经皮层入路与经胼胝体入路中均无显著性差异(p0.05);单因素及多因素分析均显示肿瘤的非典型性特点(p=0.031)及手术部分切除(p=0.037)是影响中枢神经细胞瘤复发的危险因素。31例中有5例不典型的中枢神经细胞瘤,其中术后辅助放疗比单纯手术治疗患者复发率低。结论：中枢神经细胞瘤总体预后良好,治疗应首先选择经皮层入路或经胼胝体入路显微手术切除肿瘤,达到最大安全的手术切除的目标。手术部分切除及肿瘤非典型性是影响肿瘤复发的主要危险因素。肿瘤局部复发行r刀治疗有效,不典型的肿瘤术后可辅助放射治疗。目的：2007年中枢神经系统肿瘤分类在2000年的分类的基础上将脑室外神经细胞瘤从中枢神经细胞瘤中单独列出,但二者使用相同的疾病编码(ICD-O9506/1)。本文欲探讨脑室外神经细胞瘤的临床、影像学、病理学特点及治疗方法,并研究中枢神经细胞瘤与脑室外神经细胞瘤的关系。材料与方法：回顾性研究2008年1月至2014年7月期间在我院神经外科行手术治疗并确诊的15例脑室外神经细胞瘤患者及31例脑室内中枢神经细胞瘤患者的临床、影像学、病理学及随访资料,分析脑室外神经细胞瘤的临床、影像学、病理学特点及治疗方法,并应用统计学方法比较脑室外神经细胞瘤与中枢神经细胞瘤相同点及不同点,探讨脑室外神经细胞瘤与中枢神经细胞瘤的关系。结果：本组的脑室外神经细胞瘤与中枢神经细胞瘤的组织形态学及免疫组织化学表现相似,15例脑室外神经细胞瘤的肿瘤组织由均匀一致的小圆形细胞构成并且细胞间形成特征性神经毡样结构,免疫组织化学染色显示神经突触素(Syn,15/15)、神经元特异性核蛋白(NeuN,12/15)及神经特异性烯醇化酶(NSE,2/2)阳性。15例脑室外神经细胞瘤患者均行手术治疗,1例术后2周死亡,余14例患者9例辅助放疗,其中2例口服替莫唑胺同步化疗。14例脑室外神经细胞瘤患者随访期间9例复发,其中7例再次手术全切除、2例行r刀切除,随访中无复发；随访期间2例患者的KPS70分,余恢复良好。统计学结果显示肿瘤的部分切除(p=0.041)及非典型性(p=0.013)也是影响脑室外神经细胞瘤复发的危险因素；但相比于中枢神经细胞瘤,脑室外神经细胞瘤多起病于癫痫(p=0.018)或压迫症状(p=0.005),较少出现颅内压增高(p0.05)及脑积水(p0.05)；影像学上脑室外神经细胞瘤的钙化率(p=0.044)及囊变率(p=0.029)较低；脑室外神经细胞瘤有着更广泛的组织形态学表现,较高的Ki-67指数(p=0.002)及非典型的组织学表现(p=0.027),并临床上伴随更高的复发率(p=0.044)和更短的复发时间(p=0.044)。结论：脑室外神经细胞瘤与中枢神经细胞瘤有着相似的组织形态学表现及免疫表型,但脑室外神经细胞瘤表现出更广泛的组织形态学表现,更大增殖潜能及更容易复发,目前将脑室外神经细胞瘤看做单独的一种神经元和混合性神经元-神经胶质肿瘤。脑室外神经细胞瘤首选手术切除+术后放疗,肿瘤部分切除及非典型性特点容易引起肿瘤复发。
[Abstract]:Objective: To compare the clinical, imaging and pathological characteristics of central neurocytoma and explore its biological behavior.
Materials and methods: a retrospective analysis of 31 cases of central neurocytoma in the brain and 46 other pathological types of tumor in the lateral ventricle from January 2008 to July 2014 in our hospital (25 cases of ependymoma, 7 cases of oligodendroma, 7 cases of ependymoma, 5 diffuse astrocytomas, and 5 cases of diffuse astrocytoma) were reviewed. 2 cases of ependyma giant cell astrocytoma, clinical, imaging, pathological, immunohistochemical and other related data (including 3 cases of central neurocytoma), compared with other pathological types of tumor in the ventricle, the clinical characteristics and biological behavior of central neurocytoma were analyzed.
Results: compared to other pathological types of tumor in the brain, central neurocytoma occurs mainly in young people around 30 years of age (p=0.023) and a little more male. In clinical, central neurocytoma shows more symptoms of increased intracranial pressure caused by obstructive hydrocephalus (p=0.004), and most of the symptoms are within 6 months (p=0.373). Cerebral hydrocephalus (p=0.006) and optic papillematous edema (p=0.045). Central neurocytoma is mostly located in the lateral ventricle frontal and interventricular orifice area (p=0.001), with clear boundaries, no invasion of the surrounding structure (P0.05), and easy to merge calcification, cysts and vascular empties (P0.05). Histologically, central neurocytoma is a source of central neurocytoma. The same size, compact round small tumor cells and fibrous Islands (neuroblastoma) located in a nuclear free zone, atypical histopathology such as nuclear heterotypic, vascular proliferation and necrosis in central neurocytoma; immuno histochemistry is neurosynapse (Syn), neuron specific nucleoprotein (NeuN) and nerve Specific enolase (NSE) was positive, and the proliferation related Ki-67 index of nuclear antigen was low. The average of 3 cases of central neurocytoma in 2.37%.31 cases showed atypical histopathological features including nuclear heterotypic and vascular proliferation. 3 cases of proton magnetic resonance wave imaging showed significant choline (Cho) peak and decrease. The N- acetyl aspartic acid (NAA) peak. 3 cases of electron microscopy showed that there were neurosecretory granules in the cytoplasm of the tumor cells, and the atypical synaptic structure was formed and the synapses contained a large number of clear vesicles and microtubule structures.
Conclusion: compared with other pathological types of tumors in the ventricle, central neurocytoma has typical clinical, imaging, histopathological, immunohistochemical and electron microscopy features, which can establish an accurate clinical diagnosis based on these characteristics. Central neurocytoma is mainly differentiated into neurons and most of them have benign biological lines. As a result, there are very few atypical changes or distant metastases.
Objective: To explore the treatment strategy for central neurocytoma.
Materials and methods: a retrospective analysis of the clinical, surgical and postoperative follow-up data of 31 cases of intracerebral central neurocytoma from January 2008 to July 2014 in our hospital. The relevant statistical methods were used to compare the surgical resection of the two kinds of cortical and corpus callosum in the treatment of central neurocytoma. In addition to the degree, postoperative complications and clinical outcomes, and to analyze the risk factors affecting the recurrence of central neurocytoma, the treatment strategy of CNS was further explored.
Results: 31 cases of central neurocytoma were treated with microsurgery, 1 cases died within 1 months after the operation, 16 of the 30 patients were assisted with adjuvant radiotherapy, 1 cases were combined with temozolomide, 30 patients were followed up with 9 cases, of which 6 cases were treated with R knife, 3 cases underwent craniotomy tumor microsurgery again, and were not followed up during the follow-up period. The recurrence was seen again. The KPS score of 5 patients in the follow-up was 70.31 cases of central neurocytoma resection, and postoperative complications and clinical outcomes were not significantly different between the percutaneous approach and the corpus callosum approach (P0.05); the univariate and multifactor analysis showed the tumor's atypical characteristics (p=0.031) and surgical partial excision (p=0 .037) is a risk factor affecting the recurrence of central neurocytoma. There are 5 cases of atypical central neurocytoma in.31 cases, of which postoperative adjuvant radiotherapy is lower than that of simple surgical treatment.
Conclusion: central neurocytoma has a good overall prognosis. Treatment should be first selected through the cortical approach or the corpus callosum approach to remove the tumor to achieve the maximum safe surgical removal. Surgical partial resection and atypical tumor are the main risk factors affecting the recurrence of the tumor. The local reissue of R knife is effective. A typical tumor can be assisted by radiotherapy after surgery.
Objective: in 2007, the classification of central nervous system tumors on the basis of classification in 2000 would be based on a separate list of central neurocytomas from central neurocytoma, but the two used the same disease code (ICD-O9506/1). This article is intended to explore the clinical, imaging, pathological features and treatment of the outdoors neurocytoma of the brain, and to study the center of the brain. The relationship between neurocytoma and extraventricular neurocytoma.
Materials and methods: the clinical, imaging, pathological and follow-up data of 15 patients with intracerebral outdoors neurocytoma and 31 cases of intraventricular neurocytoma in the Department of Neurosurgery of our hospital from January 2008 to July 2014 were reviewed, and the clinical, imaging and pathological features of extraventricular neurocytoma were analyzed. Points and treatment methods were used to compare the similarities and differences between the extraventricular neurocytoma and central neurocytoma, and to explore the relationship between the extraventricular neurocytoma and central neurocytoma.
Results: the histopathological and immunohistochemical features of the peripheral neurocytoma in this group were similar to those of central neurocytoma. The tumor tissues of 15 cases of brain outdoors neurocytoma were composed of uniform and uniform small circular cells and formed a characteristic neurogenic structure between cells. Immunohistochemical staining showed neurosynapse (Syn). 15/15), NeuN, 12/15, and NSE (2/2) positive.15 patients with positive brain outdoors neurocytoma were treated with surgical treatment. 1 cases died 2 weeks after operation and 9 cases were assisted with radiotherapy in the remaining 14 cases, of which 2 cases were followed up with temozolomide and.14 cases of cerebral outdoor neurocytoma were followed up for 9 cases. 7 cases were completely resected and 2 cases were excised with R knife, and no recurrence was found during the follow-up. The KPS70 scores of 2 patients were recovered well during the follow-up period. Statistical results showed that partial resection of the tumor (p=0.041) and atypical (p=0.013) were also the risk factors for the recurrence of extraventricular neurocytoma, but compared to central neurocytoma and extraventricular. Neurocytoma occurs most in epileptic (p=0.018) or compression symptoms (p=0.005), less intracranial pressure (P0.05) and hydrocephalus (P0.05); the calcification rate (p=0.044) and cystic change rate (p=0.029) in the image of extraventricular neurocytoma (p=0.029) are lower, and the extra ventricular extraventricular neurocytoma has a more extensive histomorphology, and a higher Ki-67 index (p=0.). 002) and atypical histological findings (p=0.027), and clinically associated with higher recurrence rate (p=0.044) and shorter recurrence time (p=0.044).
Conclusion: extraventricular neurocytoma has similar histomorphological features and immunophenotype with central neurocytoma, but extraventricular neurocytoma shows more extensive histomorphology, greater proliferation potential and more recurrence. At present, extraventricular neurocytoma is regarded as a single type of neuron and mixed nerve. Tumor resection is the first choice for patients with extraventricular neurocytoma.
【学位授予单位】：华中科技大学
【学位级别】：博士
【学位授予年份】：2015
【分类号】：R739.4

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