本文選題：中樞神經(jīng)細(xì)胞瘤 + 腦室內(nèi)腫瘤��； 參考：《華中科技大學(xué)》2015年博士論文

【摘要】：目的：對(duì)比腦室內(nèi)其他病理類型的腫瘤,研究中樞神經(jīng)細(xì)胞瘤的臨床、影像學(xué)及病理學(xué)的特點(diǎn),并探討其生物學(xué)行為。 材料與方法：回顧性分析我院自2008年1月至2014年7月行手術(shù)治療并診斷的31例腦室內(nèi)中樞神經(jīng)細(xì)胞瘤患者及同期診治的46例側(cè)腦室內(nèi)的其他病理類型腫瘤患者(25例室管膜瘤、7例少突膠質(zhì)細(xì)胞瘤、7例室管膜下瘤、5例彌漫性星形細(xì)胞瘤及2例室管膜下巨細(xì)胞型星形細(xì)胞瘤)的臨床、影像學(xué)、病理學(xué)、免疫組織化學(xué)等相關(guān)資料(包括3例中樞神經(jīng)細(xì)胞瘤患者的電鏡檢查資料),對(duì)比腦室內(nèi)其他病理類型的腫瘤,分析中樞神經(jīng)細(xì)胞瘤的臨床相關(guān)特點(diǎn)及生物學(xué)行為。 結(jié)果：相比于腦室內(nèi)其他病理類型的腫瘤,中樞神經(jīng)細(xì)胞瘤主要發(fā)生于30歲左右的青年人(p=0.023),男性稍多。在臨床上中樞神經(jīng)細(xì)胞瘤多表現(xiàn)出因阻塞性腦積水導(dǎo)致的顱內(nèi)壓增高的癥狀(p=0.004),且癥狀大多數(shù)在6個(gè)月以內(nèi)(p=0.373),容易合并腦積水(p=0.006)及視神經(jīng)乳頭水腫(p=0.045)。影像學(xué)上中樞神經(jīng)細(xì)胞瘤多位于側(cè)腦室額角及室間孔區(qū)(p=0.001),邊界清楚、不侵及腫瘤周邊的結(jié)構(gòu)組織(p0.05),并容易合并鈣化、囊變及血管流空影(p0.05)。組織病理學(xué)上中樞神經(jīng)細(xì)胞瘤是由來(lái)源相同的一致大小的較密集圓形的小的瘤細(xì)胞和位于無(wú)核區(qū)成片的纖維島(神經(jīng)氈)組成,非典型的組織病理學(xué)如核異型、血管增生及壞死在中樞神經(jīng)細(xì)胞瘤中少見；免疫組織化學(xué)表現(xiàn)為神經(jīng)突觸素(Syn)、神經(jīng)元特異性核蛋白(NeuN)及神經(jīng)特異性烯醇化酶(NSE)陽(yáng)性,并且細(xì)胞增殖相關(guān)的核抗原Ki-67指數(shù)較低,平均為2.37%。31例中樞神經(jīng)細(xì)胞瘤中的3例在光鏡下表現(xiàn)出非典型的組織病理學(xué)特點(diǎn)包括核異型及血管增生,3例氫質(zhì)子磁共振波普成像表現(xiàn)出顯著的膽堿(Cho)峰及降低的N-乙酰天冬氨酸(NAA)峰,3例電鏡結(jié)果顯示腫瘤細(xì)胞胞質(zhì)內(nèi)有神經(jīng)分泌顆粒,并形成非典型突觸結(jié)構(gòu)及突觸內(nèi)含有大量清亮的囊泡及微管結(jié)構(gòu)。 結(jié)論：與腦室內(nèi)其他病理類型的腫瘤相比,中樞神經(jīng)細(xì)胞瘤具有典型的臨床、影像學(xué)、組織病理學(xué)、免疫組織化學(xué)及電鏡學(xué)的特點(diǎn),依據(jù)這些特點(diǎn)可建立準(zhǔn)確的臨床診斷,中樞神經(jīng)細(xì)胞瘤主要向神經(jīng)元分化并大多數(shù)具有良性的生物學(xué)行為,極少數(shù)出現(xiàn)非典型改變或遠(yuǎn)處轉(zhuǎn)移。 目的：探討中樞神經(jīng)細(xì)胞瘤的治療策略。 材料與方法：回顧性分析自2008年1月至2014年7月于我院行手術(shù)治療并確診的31例腦室內(nèi)中樞神經(jīng)細(xì)胞瘤的臨床、手術(shù)及手術(shù)后的隨訪資料。應(yīng)用相關(guān)的統(tǒng)計(jì)學(xué)方法比較經(jīng)皮層及經(jīng)胼胝體兩種手術(shù)方式在治療中樞神經(jīng)細(xì)胞瘤中的手術(shù)切除程度、術(shù)后并發(fā)癥及臨床結(jié)局的差異,并分析影響中樞神經(jīng)細(xì)胞瘤復(fù)發(fā)的相關(guān)危險(xiǎn)因素,進(jìn)一步探討中樞神經(jīng)細(xì)胞瘤的治療策略。 結(jié)果：31例中樞神經(jīng)細(xì)胞瘤患者均行顯微手術(shù)治療,1例于術(shù)后1個(gè)月內(nèi)死亡,余30例患者中有16例輔助放射治療,1例同步輔助口服替莫唑胺化療；30例患者隨訪中有9例復(fù)發(fā),其中6例行r刀治療,3例再次行開顱腫瘤顯微切除術(shù),隨訪期間未見再次復(fù)發(fā),隨訪中5例患者的KPS評(píng)分70分。31例中樞神經(jīng)細(xì)胞瘤的手術(shù)切除程度、術(shù)后并發(fā)癥及臨床結(jié)局在經(jīng)皮層入路與經(jīng)胼胝體入路中均無(wú)顯著性差異(p0.05);單因素及多因素分析均顯示腫瘤的非典型性特點(diǎn)(p=0.031)及手術(shù)部分切除(p=0.037)是影響中樞神經(jīng)細(xì)胞瘤復(fù)發(fā)的危險(xiǎn)因素。31例中有5例不典型的中樞神經(jīng)細(xì)胞瘤,其中術(shù)后輔助放療比單純手術(shù)治療患者復(fù)發(fā)率低。 結(jié)論：中樞神經(jīng)細(xì)胞瘤總體預(yù)后良好,治療應(yīng)首先選擇經(jīng)皮層入路或經(jīng)胼胝體入路顯微手術(shù)切除腫瘤,達(dá)到最大安全的手術(shù)切除的目標(biāo)。手術(shù)部分切除及腫瘤非典型性是影響腫瘤復(fù)發(fā)的主要危險(xiǎn)因素。腫瘤局部復(fù)發(fā)行r刀治療有效,不典型的腫瘤術(shù)后可輔助放射治療。 目的：2007年中樞神經(jīng)系統(tǒng)腫瘤分類在2000年的分類的基礎(chǔ)上將腦室外神經(jīng)細(xì)胞瘤從中樞神經(jīng)細(xì)胞瘤中單獨(dú)列出,但二者使用相同的疾病編碼(ICD-O9506/1)。本文欲探討腦室外神經(jīng)細(xì)胞瘤的臨床、影像學(xué)、病理學(xué)特點(diǎn)及治療方法,并研究中樞神經(jīng)細(xì)胞瘤與腦室外神經(jīng)細(xì)胞瘤的關(guān)系。 材料與方法：回顧性研究2008年1月至2014年7月期間在我院神經(jīng)外科行手術(shù)治療并確診的15例腦室外神經(jīng)細(xì)胞瘤患者及31例腦室內(nèi)中樞神經(jīng)細(xì)胞瘤患者的臨床、影像學(xué)、病理學(xué)及隨訪資料,分析腦室外神經(jīng)細(xì)胞瘤的臨床、影像學(xué)、病理學(xué)特點(diǎn)及治療方法,并應(yīng)用統(tǒng)計(jì)學(xué)方法比較腦室外神經(jīng)細(xì)胞瘤與中樞神經(jīng)細(xì)胞瘤相同點(diǎn)及不同點(diǎn),探討腦室外神經(jīng)細(xì)胞瘤與中樞神經(jīng)細(xì)胞瘤的關(guān)系。 結(jié)果：本組的腦室外神經(jīng)細(xì)胞瘤與中樞神經(jīng)細(xì)胞瘤的組織形態(tài)學(xué)及免疫組織化學(xué)表現(xiàn)相似,15例腦室外神經(jīng)細(xì)胞瘤的腫瘤組織由均勻一致的小圓形細(xì)胞構(gòu)成并且細(xì)胞間形成特征性神經(jīng)氈樣結(jié)構(gòu),免疫組織化學(xué)染色顯示神經(jīng)突觸素(Syn,15/15)、神經(jīng)元特異性核蛋白(NeuN,12/15)及神經(jīng)特異性烯醇化酶(NSE,2/2)陽(yáng)性。15例腦室外神經(jīng)細(xì)胞瘤患者均行手術(shù)治療,1例術(shù)后2周死亡,余14例患者9例輔助放療,其中2例口服替莫唑胺同步化療。14例腦室外神經(jīng)細(xì)胞瘤患者隨訪期間9例復(fù)發(fā),其中7例再次手術(shù)全切除、2例行r刀切除,隨訪中無(wú)復(fù)發(fā)；隨訪期間2例患者的KPS70分,余恢復(fù)良好。統(tǒng)計(jì)學(xué)結(jié)果顯示腫瘤的部分切除(p=0.041)及非典型性(p=0.013)也是影響腦室外神經(jīng)細(xì)胞瘤復(fù)發(fā)的危險(xiǎn)因素；但相比于中樞神經(jīng)細(xì)胞瘤,腦室外神經(jīng)細(xì)胞瘤多起病于癲癇(p=0.018)或壓迫癥狀(p=0.005),較少出現(xiàn)顱內(nèi)壓增高(p0.05)及腦積水(p0.05)；影像學(xué)上腦室外神經(jīng)細(xì)胞瘤的鈣化率(p=0.044)及囊變率(p=0.029)較低；腦室外神經(jīng)細(xì)胞瘤有著更廣泛的組織形態(tài)學(xué)表現(xiàn),較高的Ki-67指數(shù)(p=0.002)及非典型的組織學(xué)表現(xiàn)(p=0.027),并臨床上伴隨更高的復(fù)發(fā)率(p=0.044)和更短的復(fù)發(fā)時(shí)間(p=0.044)。 結(jié)論：腦室外神經(jīng)細(xì)胞瘤與中樞神經(jīng)細(xì)胞瘤有著相似的組織形態(tài)學(xué)表現(xiàn)及免疫表型,但腦室外神經(jīng)細(xì)胞瘤表現(xiàn)出更廣泛的組織形態(tài)學(xué)表現(xiàn),更大增殖潛能及更容易復(fù)發(fā),目前將腦室外神經(jīng)細(xì)胞瘤看做單獨(dú)的一種神經(jīng)元和混合性神經(jīng)元-神經(jīng)膠質(zhì)腫瘤。腦室外神經(jīng)細(xì)胞瘤首選手術(shù)切除+術(shù)后放療,腫瘤部分切除及非典型性特點(diǎn)容易引起腫瘤復(fù)發(fā)。
[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.
【學(xué)位授予單位】：華中科技大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2015
【分類號(hào)】：R739.4

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