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目的:探讨脑膜瘤的组织发生、病理学特点、分型与临床预后。方法:采用全自动免疫组化Ventana法对60例(包括2例特殊部位)脑膜瘤的组织发生、病理学特点、分型与临床预后的关系进行回顾性分析。结果:60例脑膜瘤中WHOⅠ级有57例,其中皮细胞型19例,纤维型23例,过渡型10例,化生型2例,砂砾体型2例,血管瘤型1例,WHOⅡ级有3例,均为非典型性脑膜瘤。肿瘤发生在大脑凸面者占53.3%(32/60例),大脑镰旁16.7%(10/60例),小脑桥脑角及其它部位共占30%(18/60例)。免疫组化检测显示:Vimentin、EMA阳性表达率均为96.7%(58/60例),PR阳性表达率69.2%(42/60例);S-100阳性表达率47.4%(28/60例);CK阳性表达率10%(6/60例);GFAP阳性表达率8.3%(5/60例);Ki-67阳性表达指数在WHOⅠ级中平均为4.9%,WHOⅡ级中平均为13.3%。其中,鼻窦脑膜瘤EMA、Vimentin及S-100均为阳性,PR少数细胞阳性。侧脑室脑膜瘤Vimentin和S-100阳性,EMA和PR灶状阳性。结论:脑膜瘤的组织学分级大部分为WHO Ⅰ级,少部分为Ⅱ级(非典型性)和Ⅲ级(间变型),共15种组织学亚型。颅外与颅内脑膜瘤的组织学形态基本相同。该肿瘤大部分预后良好,但部分术后可复发,且有肿瘤病理分级越高,复发率越高的现象。
Objective: To investigate the histogenesis, pathological features, classification and clinical prognosis of meningiomas. Methods: The histopathology, pathological features, classification and clinical prognosis of 60 cases (including 2 cases of specific sites) of meningiomas were retrospectively analyzed by the method of automatic immunohistochemistry. Results: There were 57 cases of WHO grade Ⅰ in 60 meningioma cases, including 19 cases of epithelial cell type, 23 cases of fibrous type, 10 cases of transitional type, 2 metaplastic cases, 2 cases of gravel body, 1 case of hemangioma, 3 cases were atypical meningioma. Tumors were found in 53.3% (32/60) cases of convex brain, 16.7% (10/60 cases) of falx falx, and 30% (18/60 cases) of cerebellar pontine angle and other parts. Immunohistochemical examination showed that the positive expression rate of Vimentin and EMA was 96.7% (58/60), the positive rate of PR was 69.2% (42/60), the positive rate of S-100 was 47.4% (28/60) ; The positive expression rate of CK was 10% (6/60); the positive expression rate of GFAP was 8.3% (5/60); the positive expression index of Ki-67 was 4.9% in WHOⅠstage and 13.3% in WHOⅡstage. Among them, sinus meningioma EMA, Vimentin and S-100 were positive, PR minority cells were positive. Vimentin and S-100 were positive in lateral ventricular meningiomas, with positive EMA and PR lesions. Conclusion: Most of the histological grading of meningiomas are WHO grade Ⅰ, a small number of grade Ⅱ (atypical) and Ⅲ grade (anaplastic), a total of 15 histological subtypes. Extracranial and intracranial meningiomas histological morphology is basically the same. Most of the tumor with a good prognosis, but some may relapse after surgery, and the higher the tumor pathological grade, the higher the recurrence rate of the phenomenon.