论文部分内容阅读
目的分析荧光素钠(FL)标记下,胶质母细胞瘤(GBM)肿瘤实质、瘤脑边界、瘤周水肿的荧光显影程度,探讨肿瘤分子病理学标志物在肿瘤不同区域的表达,提供术中根据荧光性质评估肿瘤的组织学特征的线索和证据,提高荧光导航技术在胶质瘤手术中的应用水平。方法选择2014年1月至2015年6月山东大学齐鲁医院(青岛)术前经MRI诊断的GBM患者23例,其中男性14例,女性9例;年龄34~70岁,平均年龄44岁。行手术切除,术中利用FL将肿瘤染色标记,根据荧光影像(强荧光、弱荧光、无荧光)判定肿瘤的边界并切除肿瘤,比较术中所见与病理组织检查结果(包括光学显微镜检查和免疫组织化学方法检测P53、GFAP、CD28和Ki67+的表达)。结果术后病理诊断证实23例肿瘤中,GBM18例,包括多形性GBM 15例(混合间变性星形细胞瘤2例),巨细胞GBM 3例(混合间变性星形细胞瘤1例)。18例GBM荧光主要表现:肿瘤实质呈强荧光18例(100%);瘤脑边界呈强荧光12例(66.67%),弱荧光3例(16.67%),无荧光3例(16.67%);瘤周水肿无强荧光显影,弱荧光13例(72.22%),无荧光显影5例(27.78%)(P<0.05)。18例GBM免疫组织化学检测结果提示,在肿瘤实质、瘤脑边界和瘤周水肿等不同肿瘤区域,P53和GFAP表达水平差异无统计学意义(P=0.25、0.49),CD28、Ki67表达水平差异有统计学意义(P<0.05)。结论 FL标记GBM,肿瘤不同区域荧光显影程度不一,肿瘤不同区域和荧光显影部位其分子病理学标志物的表达不同;综合分析GBM荧光显影和分子病理学标志物表现,有助于术中分辨肿瘤浸润范围和预后判断。
OBJECTIVE: To analyze the extent of fluorescence imaging of glioma (GBM), tumor border and peritumoral edema with fluorescein sodium (FL), and to explore the expression of tumor molecular pathological markers in different regions of tumor Based on the fluorescence properties of tumor histological features of the clues and evidence to improve the application of fluorescent navigation technology in glioma surgery level. Methods From January 2014 to June 2015, 23 patients with GBM diagnosed preoperatively by MRI at Qilu Hospital of Qingdao University (Qingdao) were selected, including 14 males and 9 females, aged 34-70 years with a mean age of 44 years. Surgical resection, the use of intraoperative FL staining of tumor markers, according to the fluorescence images (strong fluorescence, weak fluorescence, no fluorescence) to determine the boundaries of the tumor and tumor resection, intraoperative findings and pathological findings (including optical microscopy and Immunohistochemistry was used to detect the expression of P53, GFAP, CD28 and Ki67 +). Results The pathological diagnosis confirmed that there were 18 GBM cases in GBM, including 15 cases of polymorphic GBM (2 cases of mixed astrocytoma) and 3 cases of giant cell GBM (1 cases of mixed astrocytoma). Eighteen cases of GBM fluorescence mainly showed that the tumors showed strong fluorescence in 18 cases (100%), 12 cases (66.67%) showed strong fluorescence in the border of tumor, 3 cases (16.67%) showed weak fluorescence and 16.67% Peritoneal edema without strong fluorescence imaging, weak fluorescence in 13 cases (72.22%), no fluorescence imaging in 5 cases (27.78%) (P <0.05). Immunohistochemical results of GBM in 18 cases showed that there was no significant difference in the expression of P53 and GFAP in different tumor regions such as tumor parenchyma, tumor brain border and peritumorous edema (P = 0.25,0.49), while the expression levels of CD28 and Ki67 There was statistical significance (P <0.05). CONCLUSIONS: FL-labeled GBM shows different expression levels of fluorescence in different regions of tumor and different molecular pathological markers in different regions of tumor and fluorescence imaging. Comprehensive analysis of GBM fluorescence imaging and molecular pathological markers may help to distinguish intraoperatively The extent of tumor invasion and prognosis.