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首页> 外文期刊>Neurosurgery >Aggressive vestibular schwannomas with postoperative rapid growth: clinicopathological analysis of 15 cases.
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Aggressive vestibular schwannomas with postoperative rapid growth: clinicopathological analysis of 15 cases.

机译：侵袭性前庭神经鞘瘤伴术后快速生长：15例临床病理分析。

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OBJECTIVE: Vestibular schwannomas (VSs) are known to be relatively slow-growing tumors. Some VSs, however, rapidly regrow or recur after surgical resection. Our objective was to investigate the clinicopathological characteristics of these tumors and to elucidate factors that can predict rapid regrowth or recurrence after surgical resection. METHODS: Between 1978 and 2000, 29 patients with VS underwent reoperation for regrowth or recurrence at the Department of Neurosurgery in Seoul National University Hospital. Among these patients, 15 experienced rapid VS regrowth or recurrence (annual growth rate, >15 mm/yr). The clinical, radiological, operative, and pathological findings were reviewed. For a comparison of the morphology and proliferative activity, 15 cases of VS were randomly selected as a control group from among the consecutive operative cases with tumor size larger than 4 cm treated between 1991 and 1999. Pathological parameters consisting of cellularity, pleomorphism, mitosis, necrosis, invasion to adjacent tissue, and microvascular proliferation were analyzed. Proliferative indices (e.g., Ki-67 index) also were evaluated. Statistical analyses were performed using Fisher's exact test and the analysis of variance test. RESULTS: The differences in clinical features between the aggressive VS group and the control VS group were nonspecific. The mean ages at diagnosis were 40.6 years (range, 21-63 yr) and 49.7 years (range, 35-67 yr) (P = 0.438), and the male-to-female ratios were 7:7 and 5:10 (P = 0.462), respectively. The clinical symptoms and signs were similar between the two groups. Radiologically, aggressive tumors at initial presentation had more lobulating contours than those in the control group (7 of 13 cases versus 3 of 15 cases; P = 0.001). In pathological findings, cellularity and pleomorphism were significantly higher than those in the control group (P = 0.001). However, mitosis, necrosis, invasion to adjacent tissue, and microvascular proliferation were not different between the two groups. The proliferative index (Ki-67 index) was higher in the aggressive group than in the control group (2.28 [range, 0.1-8.6] versus 0.59 [range, 0-1.5]; P = 0.034). CONCLUSION: VSs presenting with lobulating contour, high proliferative index (Ki-67 index), and high cellularity or pleomorphism require frequent radiological investigation during follow-up to facilitate early detection of regrowth or recurrence.
机译：目的：前庭神经鞘瘤（VSs）是相对生长缓慢的肿瘤。但是，有些VS在手术切除后会迅速长大或复发。我们的目的是研究这些肿瘤的临床病理特征，并阐明可以预测手术切除后快速再生长或复发的因素。方法：1978年至2000年之间，首尔国立大学医院神经外科的29例VS患者因再生长或复发而再次手术。在这些患者中，有15位经历了快速的VS再生或复发（年增长率> 15 mm /年）。回顾了临床，放射学，手术和病理学发现。为了比较形态和增殖活性，从1991年至1999年治疗的肿瘤大小大于4 cm的连续手术病例中，随机选择15例VS作为对照组。病理参数包括细胞性，多形性，有丝分裂，分析坏死，侵犯邻近组织和微血管增殖。还评估了增殖指数（例如Ki-67指数）。使用费舍尔精确检验和方差分析进行统计分析。结果：侵略性VS组和对照组VS组的临床特征无特异性。诊断时的平均年龄为40.6岁（21-63岁）和49.7岁（35-67岁）（P = 0.438），男女比例为7：7和5:10（ P = 0.462）。两组的临床症状和体征相似。放射学上，最初出现的侵袭性肿瘤比对照组具有更多的小叶轮廓（13例中的7例对15例中的3例; P = 0.001）。在病理学发现中，细胞数量和多态性显着高于对照组（P = 0.001）。然而，两组之间的有丝分裂，坏死，侵袭邻近组织和微血管增生没有差异。积极组的增殖指数（Ki-67指数）高于对照组（2.28 [范围，0.1-8.6]对0.59 [范围，0-1.5]; P = 0.034）。结论：表现为叶状轮廓，高增殖指数（Ki-67指数），高细胞性或多态性的VS需要在随访期间进行频繁的放射学检查，以促进早期发现再生或复发。

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