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首页> 外文期刊>Neuro-Oncology >Secretory meningiomas: A benign subgroup causing life-threatening complications
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Secretory meningiomas: A benign subgroup causing life-threatening complications

机译：分泌性脑膜瘤：良性亚群，可危及生命

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摘要

While meningiomas are known as slow-growing extra-cerebral neoplasms, the subgroup of secretory meningiomas with histologically benign characteristics tend to cause disproportional peritumoral edema, frequently leading to severe medical and neurological complications in postoperative management. Among 1,484 meningiomas that were resected at our institution between 1990 and 2007, 44 (3%) patients were found to have the histological diagnosis of a secretory meningioma. The clinical course, radiological appearance, and histopatho-logical features were retrospectively analyzed to examine the specifics of these benign lesions. Meningiomas were located at the convexity (n = 14), the cranial base (18), and the sphenoid ridge (12). A severe, nearly hemispheric perifocal edema disproportional to tumor size was seen on preoperative MR imaging in 18 (41%) patients. Following surgical resection, the postoperative course was uneventful in 29 patients. In 15 patients, severe peritumoral edema continued or even increased on postoperative CT imaging. Six patients showed midline shift and clinical worsening necessitating respirator-assisted ventilation and intracranial pressure monitoring. An association between the extent of brain edema and number of periodic acid Schiff-positive pseudopsammomas was found (p < 0.02). Further, the size of the edema correlated with the number of immunohistochemically detected cells expressing carcinoembryonic antigen (CEA) and cytokeratin (CK) (p < 0.01). Mean MIB-1 (Ki-67 antigen) proliferation index was 3.0% (range, 0%-17%) andrndid not correlate with edema or tumor recurrence. Secretory meningiomas are frequently associated with severe peritumoral edema. The extent of edema correlates with immunohistochemically detected expression of CEA and CK. Extended perifocal edema in meningiomas is an unusual finding and should alert the neurosurgeon that surgery may aggravate edema excessively, leading to a life-threatening postoperative situation.
机译：尽管脑膜瘤被称为缓慢生长的脑外肿瘤，但具有组织学良性特征的分泌性脑膜瘤亚组往往会引起不适当的瘤周水肿，并经常导致术后处理中严重的医学和神经系统并发症。 1990年至2007年间在我们机构切除的1,484例脑膜瘤中，有44例（3％）患者被组织学诊断为分泌性脑膜瘤。回顾性分析了临床过程，放射学表现和组织病理学特征，以检查这些良性病变的细节。脑膜瘤位于凸处（n = 14），颅底（18）和蝶骨ridge（12）。在18例（41％）的患者术前MR成像中发现了严重的，近半球形的局灶性周围水肿，与肿瘤的大小不成比例。手术切除后，有29例患者的术后过程平稳。在15例患者中，术后CT影像检查发现严重的肿瘤周围水肿持续甚至增加。 6名患者表现出中线移位和临床恶化，因此需要呼吸机辅助通气和颅内压监测。发现脑水肿程度与高碘酸希夫氏阳性假性肺泡瘤数目相关（p <0.02）。此外，水肿的大小与免疫组织化学检测到的表达癌胚抗原（CEA）和细胞角蛋白（CK）的细胞数量有关（p <0.01）。 MIB-1（Ki-67抗原）平均增殖指数为3.0％（范围为0％-17％），且与水肿或肿瘤复发无关。分泌性脑膜瘤通常与严重的肿瘤周围水肿有关。浮肿程度与免疫组化检测到的CEA和CK表达有关。脑膜瘤扩大的局灶性水肿是一个不寻常的发现，应警告神经外科医生，手术可能会过度加重水肿，导致危及生命的术后情况。

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  • 来源
    《Neuro-Oncology》 |2009年第6期|819-824|共6页
  • 作者

    Jan Regelsberger; Christian Hagel; Pedram Emami; Thorsten Ries; Oliver Heese; Manfred Westphal;

  • 作者单位

    Departments of Neurosurgery University Medical Center Hamburg-Eppendorf, Hamburg, Germany Neurochirurgische Klinik, University Medical Center Hamburg-Eppendorf, Martinistr. 52, D-20246 Hamburg, Germany;

    Neuropathology University Medical Center Hamburg-Eppendorf, Hamburg, Germany;

    Departments of Neurosurgery University Medical Center Hamburg-Eppendorf, Hamburg, Germany;

    Neuroradiology University Medical Center Hamburg-Eppendorf, Hamburg, Germany;

    Departments of Neurosurgery University Medical Center Hamburg-Eppendorf, Hamburg, Germany;

    Departments of Neurosurgery University Medical Center Hamburg-Eppendorf, Hamburg, Germany;

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  • 原文格式 PDF
  • 正文语种 eng
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  • 关键词

    brain edema; immunohistochemistry; PAS stain; secretory meningioma;

    机译：脑水肿;免疫组化;PAS染色;分泌性脑膜瘤;

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