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目的研究脑动静脉畸形(AVMs)经立体定向放射治疗后不同时期的组织病理变化。方法对10例脑AVMs立体定向放射治疗后的病理标本进行苏木精-伊红染色,并用平滑肌肌动蛋白(SMA)、血管内皮生长因子(VEGF)及神经胶质酸性蛋白等抗体进行免疫组化研究。结果经立体定向放射治疗后,早期脑AVMs血管病理变化包括内膜层与血管壁分离,细胞外基质增生;中期可见平滑肌细胞增生,血管壁增厚,管腔狭窄至消失,管壁玻璃样变;晚期病理变化包括血管壁进行性增厚,在完全玻璃样变的区域细胞核固缩。早期放射反应的动脉管壁中VEGF呈阳性表达,在中期放射反应的动脉管壁中SMA呈强阳性表达。结论立体定向放射治疗后脑AVMs血管中层的平滑肌细胞增生和变性是血管闭塞的关键因素。
Objective To study the histopathological changes of cerebral arteriovenous malformations (AVMs) at different stages after stereotactic radiotherapy. Methods 10 cases of brain AVMs after stereotactic radiotherapy pathological specimens were stained with hematoxylin-eosin, and with smooth muscle actin (SMA), vascular endothelial growth factor (VEGF) and glial acid protein antibodies for immunization Research. Results After stereotactic radiotherapy, vascular pathological changes of early brain AVMs included the separation of the intima and the vascular wall and the proliferation of extracellular matrix. The proliferation of smooth muscle cells, thickening of the vascular wall and stenosis disappeared in the mid-term, ; Advanced pathological changes include progressive thickening of the vessel wall, nuclear condensation in a completely vitreous area. The early radiation reaction in the arterial wall VEGF expression was positive, mid-term radioactive arterial wall SMA was strongly positive expression. Conclusion The proliferation and degeneration of smooth muscle cells in vascular AVMs after stereotactic radiotherapy are the key factors of vascular occlusion.