肿瘤,神经上皮

摘要： 目的 探讨胚胎发育不良性神经上皮肿瘤的MRI分型与癫(癎)预后的关系.方法 选择2012年1月至2019年7月经术后病理证实的14例胚胎发育不良性神经上皮肿瘤患者,收集其临床、影像、病理以及随访资料,分析影响其癫(癎)预后的相关因素.结果 14例患者均以癫(癎)发作起病,MRI分型8例为Ⅰ型,4例为Ⅱ型,2例为Ⅲ型.14例患者均经手术全切除肿瘤.术后病理HE染色均见特异性神经元成分,13例行免疫组化染色患者突触素、少突胶质细胞转录因子2和神经元核抗原均为阳性.术后随访6～ 84个月,MRI分型Ⅰ型患者术后癫(癎)发作控制达Engel Ⅰ级;Ⅱ型患者2例术后癫(癎)发作控制达Engel Ⅰ级,2例达EngelⅢ级;Ⅲ型患者2例术后癫(癎)发作控制均达EngelⅡ级.结论 胚胎发育不良性神经上皮肿瘤切除术后癫(癎)预后可能与MRI分型相关,MRI分型Ⅰ型患者较Ⅱ型和Ⅲ型患者术后癫(癎)预后更好.

摘要： 目的 探究扩散加权成像(DWI)联合波谱成像技术(MRS)在评估胶质瘤等级中的临床应用价值.方法 回顾性分析自2017年1月至2020年8月就诊于大连大学附属新华医院的103例脑胶质瘤患者的临床资料.根据WHO中枢神经系统肿瘤分类,将病例分为两组:低级别胶质瘤(LGG)组(54例)和高级别胶质瘤(HGG)组(49例).比较两组术前的磁共振检查结果中扩散系数(ADC),相对扩散系数(rADC))、胆碱(Cho)、肌酸(Cr)和N-乙醇天门东氨酸(NAA)的差异性.结果 HGG组和LGG组中,ADC的比值分别为(1.51±0.47)×10-3 mm2/s和(1.37±0.29)×10-3 mm2/s(P<0.01);rADC比值分别为(1.87±0.49)×10-3 mm2/s和(1.66±0.37)×10-3 mm2/s(P<0.01);Cho/Cr的比值分别为2.21±0.46和4.02±0.48(P<0.01);Cho/NAA的比值分别为2.19±0.41和4.21±0.58(P<0.01);NAA/Cr的比值分别为0.81±0.22和0.47±0.11(P<0.01).受试者工作特征曲线(ROC)结果显示ADC、rADC、Cho/Cr、Cho/NAA和NAA/Cr的曲线下面积分别为0.750、0.842、0.766、0.801及0.751,差异均有统计学意义.结论 DWI及MRS在术前评估脑胶质瘤级别方面具有很高的应用价值,弥补了MRI常规序列的不足,对临床医生诊疗方案的制定起指导作用.

摘要： 目的 探讨年轻人多形性低级别神经上皮肿瘤(PLNTY)的临床病理学特征、诊断及预后.方法 收集浙江省宁波市临床病理诊断中心2016年1月至2019年12月确诊的2例PLNTY,观察其临床特征、组织学形态、免疫表型和分子遗传学特征,并结合文献进行复习和总结.结果 2例患者均为女性,年龄分别为14岁和25岁,临床上均以癫痫发作为主要表现.影像学检查显示大脑皮层混杂性信号,分别位于枕叶和颞叶.镜下观察肿瘤组织均有特征性的少突胶质细胞瘤样的形态结构,常伴有钙化.免疫组织化学标记显示瘤细胞CD34弥漫强阳性,周围皮层神经元CD34阳性表达呈毛刺状;胶质纤维酸性蛋白(GFAP)、Olig2和ATRX阳性,IDH1阴性,其他标志物包括Neu N、巢蛋白和上皮细胞膜抗原(EMA)等均阴性,Ki-67阳性指数均＜2％.分子检测例2显示BRAF V600E突变,例1显示无BRAF V600E突变和1p/19q共缺失.术后随访2和24个月,患者情况良好,未见癫痫发作.结论 PLNTY是一种少见的低级别神经上皮肿瘤,确诊依赖病理学诊断,并需与少突胶质细胞瘤进行鉴别.PLNTY相当于WHO Ⅰ级肿瘤,手术完全切除肿块后,预后良好.

摘要： Objective To investigate the MRI classifications and imaging findings of dysembryoplastic neuroepithelial tumor(DNET). Methods MR images of 34 patients with pathologic confirmed DNET of Beijing Sanbo Brain Hospital were retrospectively reviewed in this study. The classification was made according to the number of pseudocysts, scope of involvement, morphology and location. Results MRI appearances of DNET were divided into three subtypes: cystic‐like, polycystic‐like and diffuse type. Twelve cases had cystic cortical, including front lobe (5 cases), temporal lobe (5 cases), parietal lobe (2 cases). These cases presented quasi‐circular or oval shape, with hypointense on T1WI and strongly hyperintense on T2WI. T2‐FLAIR was observed hyperintense ring sign in the tumor periphery and the cystic content was close to CSF but having the largest difference to that of CSF, which signal was higher than CSF. Twenty cases were polycystic‐like, front lobe (7 cases), temporal lobe (7 cases), parietal lobe (5 cases), occipital lobe (1 case). In these 20 cases, they had slightly hypointense on T1WI and strongly hyperintense on T2WI. Located in the cortex and subcortical matter, with wedge shape, gyriform or triangle shape.On T2‐FLAIR, internal septation and hyperintense"ring sign"were observed. Two cases were diffuse type, bilateral (1 case), unilateral (1 case). In these 2 cases, diffuse lesions involving multiple areas with hyperintense ring and internal septation on FLAIR, including subcortical white matter, deep nucleus and periventricular area. Conclusions The MR appearances of DNET are variable. Understanding the MR imaging type of DNET might improve the MR diagnosis of DNET.%目的 探讨胚胎发育不良性神经上皮肿瘤(DNET)的MRI分型及影像表现.方法 回顾性搜集首都医科大学三博脑科医院2009年5月至2018年5月,34例经手术病理证实的DNET患者的影像资料,所有患者均进行MR平扫和增强检查,根据囊性病变数量、内部结构、累及范围、形态及部位等对DNET进行分型.结果 DNET的MRI表现可分为单囊型、多囊型及弥漫型.单囊型12例,额叶5例、颞叶5例、顶叶2例.12例均局限于皮层,9例为圆形、类圆形,3例为不规则形.12例在T1WI上均表现为稍低信号影,T2WI上均表现为高信号影,与脑脊液信号相当,FLAIR较脑脊液信号稍高,边缘见高信号"环征".5例颅骨变薄.1例可见强化.8例误诊.多囊型20例,额叶7例、颞叶7例、顶叶5例、枕叶1例.15例表现为楔形或三角形,5例脑回形.所有病变均在T1WI上表现为稍低信号影,T2WI上均表现为高信号影,FLAIR像上病变内见多分隔影及高信号"环征",4例颅骨变薄.2例可见少许强化.2例误诊.弥漫型2例,双侧1例、单侧1例.表现为多发囊性病变弥漫累及多个部位.2例均可见少许出血信号.1例误诊.结论 DNET的影像表现多样,可分为单囊型、多囊型及弥漫型3种类型,DNET的MRI分型有助于提高其诊断和认识,减少误诊率.

摘要： 目的:观察hMLH1基因对脑胶质瘤替莫唑胺耐药的影响并探讨其机制.方法:检测脑胶质瘤患者组织、耐药细胞株(U251/TMZ)和亲本敏感细胞株(U251)的hMLH1表达水平;使用5氮杂-2'-脱氧胞苷(5-Aza-CdR)予耐药细胞株去甲基化干预后,采用MBP法检测其hMLH1基因启动子甲基化水平;检测干预前后耐药细胞株的hMLH1表达水平以及替莫唑胺IC50的变化.结果:脑胶质瘤复发患者组织hMLH1表达水平低于初治患者;耐药细胞株hMLH1表达水平低于敏感细胞株,去甲基化干预后耐药细胞株hMLH1表达水平及对替萸唑胺敏感性增加.结论:hMLH1沉默促进脑胶质瘤替莫唑胺耐药,其机制可能与该基因启动子甲基化增强有关.

摘要： Dysembryoplastic neuroepithelial tumor (DNT) has traditionally been viewed as rare benign tumors that present with seizure widely considered curable with surgery alone.Most DNTs occur in childhood and young adults.However,rare reported cases occur in infants.This paper reported an infant case of DNT and its diagnosis,differential diagnosis,treatment,molecular features and prognosis based on the review of current literatures.The age onset of this patient was only 11 months old.The clinical manifestations were partial seizures and the imaging data untypical;CT and MRI were all supportive of astrocytoma.Typical glioneuronal element histologic features could be seen,which contained oligodendrocyte-like cells attached to bundles of axons and neurons floating in a myxoid interstitial fluid.Meanwhile,some atypical regions could also be seen.These atypical regions showed a mixture of oligodendrocyte-like cells and neurons without a myxoid interstitial fluid,which were easily misdiagnosed.The BRAFV600E mutation was not detected.This patient had a good response to drug therapy.Totally surgical resection of the tumor was conducted.The patient had been seizures free for 6 months.In conclusion,DNT is a rare and well prognostic tumor (WHO grade Ⅰ),which most often arise in children in the setting of medically refractory epilepsy.The most common tumor location was temporal.Because clinical symptoms,imaging and histological features of DNT and other low-grade gliomas broadly overlap such as ganglioglioma,pilocytic astrocytomas and oligodendroglioma et al.,differential diagnosis should be made carefully.The glioneuronal element was the histopathological hallmark of DNT.In addition,some untypical regions should also be called attention.Although BRAFV600E mutation didn't exist in this case,it played a role in differential diagnosis because it has been previously recorded that BRAFV600E mutation was a common feature of DNT.Infant patients have their own characteristics.For example,drug therapy worked well and the imaging data was untypical.Doctors should improve the understanding of this disease to avoid unnecessary radiotherapy or chemotherapy.%报告1例婴儿左颞叶胚胎发育不良性神经上皮肿瘤(dysembryoplastic neuroepithelial tumor,DNT)病例,介绍其临床病理特征、影像学特点、手术治疗及预后,并复习国内外文献报道,对该病的诊断、鉴别诊断以及治疗预后进行综合分析,以提高临床及病理医生对这一少见疾病的认识.本例发病年龄早,患儿仅11个月大,临床表现为部分性癫痫发作,但药物反应较好,影像学提示左颞叶占位并怀疑星形细胞瘤,但部分层面仍具有多见于DNT的三角形特征.本例病灶体积小,组织形态上不仅存在典型的特殊胶质神经元结构-黏液柱状结构,还存在一些非典型区域,周围脑实质不伴有皮层发育不良,未检测到BRAFV600E位点突变,手术全切肿瘤6个月后癫痫无发作.DNT是一种少见、预后良好的神经上皮肿瘤,婴儿期发病患者有其自身的特点.手术完整切除肿瘤效果良好,无需放射治疗或化学药物治疗.

摘要： 研究背景 胚胎发育不良性神经上皮肿瘤是神经元和混合性神经元-胶质肿瘤分类中的WHO Ⅰ级肿瘤,分为单纯型、复合型和非特殊型3种组织学亚型.由于缺乏典型的“特异性胶质神经元成分”,非特殊型胚胎发育不良性神经上皮肿瘤成为临床极具挑战性的诊断难点.本文回顾分析1例非特殊型胚胎发育不良性神经上皮肿瘤患儿的临床资料,探讨该少见亚型的诊断与鉴别诊断要点.方法 与结果 男性患儿,16岁,因反复头痛、头晕,影像学检查发现右侧额叶皮质病变入院.过去3年内至少癫(痫)发作2次,抗癫(痫)药物治疗效果不佳.MRI显示病灶呈长T1、长T2信号,无瘤周水肿,增强扫描未见强化.手术全切除病变,肿瘤内可见囊性区和囊壁上附着的神经胶质增生结节.神经胶质结节主要由少突胶质细胞瘤样细胞弥漫性分布构成,可见一些散在分布的神经元,未见典型“特异性胶质神经元成分”,邻近大脑皮质部分区域可见“微柱结构”形成,符合局灶性皮质发育不良(FCD)Ⅰ a型.免疫组织化学染色,少突胶质细胞瘤样细胞胞质突触素和胞核少突胶质细胞转录因子2弥漫性强阳性,胞质CD34、S-100蛋白和原癌基因BRAF V600E灶性阳性,Ki-67抗原标记指数约2％.荧光原位杂交未见1p/19q-共缺失.最终病理诊断为(右侧额叶)胚胎发育不良性神经上皮肿瘤,非特殊型,WHO Ⅰ级,伴局灶性皮质发育不良Ⅲb型.术后未行放射治疗和药物化疗,规律随访1年,术后第3和6个月时分别复查头部MRI,未见肿瘤复发,也未再出现癫(痫)发作.结论 非特殊型胚胎发育不良性神经上皮肿瘤组织学亚型临床少见,易误诊为低级别胶质瘤,青年患者出现癫(痫)发作和大脑皮质病变时,胚胎发育不良性神经上皮肿瘤须作为第一怀疑诊断而加以鉴别,结合CD34、R132H-突变的异柠檬酸脱氢酶1、BRAF V600E等免疫组织化学检测和1p/19q分子检测对明确诊断和组织学分型十分重要.

摘要： 目的：探讨第三脑室脊索样胶质瘤的MRI特征，提高对第三脑室脊索样胶质瘤及第三脑室其他肿瘤的认识水平。方法回顾分析5例第三脑室脊索样胶质瘤的MRI特征并结合临床资料，复习相关文献。结果5例脊索样胶质瘤患者，男4例，女1例，发病年龄25～64岁；临床主要表现为头痛、头昏、视物不清，1例女性患者月经不调。4例病灶位于第三脑室内，1例位于第三脑室前下方；5例病灶T1WI呈等低信号，T2WI呈高信号，信号不均匀；增强扫描病灶呈明显强化。5例病灶与周围脑组织边界清。结论第三脑室脊索样胶质瘤MRI表现具有特征性，MRI对肿瘤的定性、定位诊断具有参考价值，确诊仍需依靠病理学检查。

摘要： ObjectiveToevaluate the curative effect of CBCT guide glioma SIB-IMRT radiotherapy technology. Methods In our hospital from December 2011 to December 2013, 60 patients with glioma were randomly divided into research group and the control group, research group performed the team line CBCT images guided glioma SIB-IMRT radiotherapy technology, PGTV synchronization added quantity 62.5 Gy/25, completed in 33 days. The control group performed three-dimensional conformal radiation therapy, 60 Gy/30 times, completed in 40 days. During radiotherapy and after radiotherapy, evaluated the toxic effects, tumor local control rate and survival rate at the end of radiation therapy and after radiation therapy for 1 year of two groups.ResultsRadiotherapy toxicity reaction between two groups was no statistically significant difference during radiation therapy and after radiation therapy (P>0.05) . The effectiveness, disease control rate and survival rate of two groups had significant difference (P<0.05).ConclusionCBCT images guided SIB-IMRT radiation technology can shorten the treatment time, increase the tumor local control rate and survival rate. For glioma patients, it has important scientific significance and application value.%目的：评价锥形束计算机断层扫描（CBCT）引导脑胶质瘤同步加量调强放疗（SIB-IMRT）技术的应用价值。方法选取我院2011年12月至2013年12月收治的脑胶质瘤患者60例，随机分为研究组及对照组，研究组行CBCT图像引导下SIB-IMRT技术，计划肿瘤区（PGTV）同步加量62.5 Gy/25次，33 d完成。对照组行三维适形放疗，60 Gy/30次，40 d完成。放疗过程中及放疗结束后评价两组毒性反应，放疗结束后、放疗后1年评价两组肿瘤局控率及生存率。结果研究组与对照组在放疗过程中及放疗结束后放疗毒性反应无统计学差异（P＞0.05）；两组有效率、疾病控制率、生存率有统计学差异（P＜0.05）。结论 CBCT图像引导下SIB-IMRT技术缩短了治疗时间，提高肿瘤局控率及生存率，这对于脑胶质瘤患者有重要的科学意义和应用价值。

摘要： 目的 评估磁共振氨基质子转移(APT)成像在鉴别脑单发转移瘤与高级别神经上皮肿瘤方面的应用价值.方法 收集2013年3月至2014年3月南方医科大学珠江医院神经外科收治的脑单发转移瘤和高级别神经上皮肿瘤病例共83例,选取病灶的最大层面行APT序列扫描,将经手术病理证实的34例脑转移瘤(34个病灶)和49例高级别神经上皮肿瘤(49个病灶)APT图像结合常规MRI图像划分出瘤核心区和瘤旁区两个感兴趣区域,测量APT转移率(APTR)并构建伪彩图,分别比较转移瘤与高级别神经上皮肿瘤的瘤核心、瘤旁区的APTR差异.应用受试者特性曲线分析鉴别两者的最佳界值.结果 伪彩图示转移瘤组与高级别神经上皮肿瘤组的瘤核心信号强度相近,但两组瘤旁区信号差异较为明显;转移瘤组与高级别神经上皮肿瘤组瘤核心区APTR分别为(2.92±0.51)％和(3.06±0.56)％,两者之间差异无统计学意义(P=0.233);转移瘤组和高级别神经上皮肿瘤组瘤旁区APrR分别为(1.47±0.23)％和(1.81±0.31)％,两者之间差异有统计学意义(P=0.000).结论 APT成像结合常规序列,特别是量化瘤旁区的APTR,对转移瘤和高级别神经上皮肿瘤的鉴别诊断有一定的临床应用价值.%Objective To investigate the application value of identification of the solitary metastatic tumors and the high-grade neuroepithelial tumors with amide proton transfer (APT) magnetic resonance imaging.Methods A total of 83 patients with metastatic tumor and high-level neuroepithelial tumor admitted at the Department of Neurosurgery,Zhujiang Hospital,Southern Medical University from March 2013 to March 2014 were enrolled.The patients with metastatic tumor and high-level neuroepithelial tumor newly diagnosed by conventional magnetic resonance imaging performed APT sequential scan.For the 34 patients with metastatic tumor (34 foci) and 49 patients with high-grade neuroepithelial tumors (49 foci) confirmed by surgery,the APT images divided the tumor core areas and two regions of interest of paratumor areas.The amide proton transfer ratio (APTR) was measured and the pseudo-color images were constructed.The APTR differences of the tumor cores and the paratumor areas between the metastatic tumors and the high-level neuroepithelial tumors were compared respectively using two independent sample t tests.Simultaneously,the receiver operating characteristic curve analysis was used to identify the best cut-off values of both.Results The pseudo-color images showed that the tumor core signal intensity was similar between the metastatic tumor group and the high-grade neuroepithelial tumor group,but the signal difference of the paratumor area was more obvious.The tumor core area APTRs in the metastatic tumor group and the high-grade neuroepithelial tumor group were (2.92 ±0.51)％ and (3.06 ±0.56)％ respectively.There was no significant difference between the two groups (P =0.233).The peritumoral area APTRs in the metastatic tumor group and the high-grade neuroepithelial tumor group were (1.47 ± 0.23)％ and (1.81 ± 0.31)％ respectively.There was significant difference between the two groups(P =0.000).Conclusions APT imaging combined with conventional sequence,in particular the APTR of quantitative paratumor area,has certain clinical value for the differential diagnosis of the metastatic tumors and the high-grade neuroepithelial tumors.

摘要： 提供一种建立神经上皮干细胞的培养基、方法及其应用。所述培养基包括用于将多能干细胞诱导分化为初级神经上皮干细胞的分化培养基及用于使初级神经上皮干细胞扩增的扩增培养基。

摘要： 本发明公开了一种快速直接定向诱导鼠胚胎干细胞分化为神经上皮细胞的方法，通过向贴壁培养的鼠胚胎干细胞团状克隆中加入含有dorsomorphin与noggin、SB431542和CHIR99021的诱导培养基，诱导鼠胚胎干细胞细胞形成玫瑰花状神经球；随后加入含有bFGF的第二阶段诱导培养基悬浮培养形成悬浮的神经球；最后将神经球消化成单细胞，然后用第三阶段诱导培养基贴壁培养形成具有较长期的自我增殖与更新的神经上皮细胞。本发明摒弃了传统的形成EB方法，缩短了分化时间，而且分化的效率达到了95％以上。本发明可快速诱导NE细胞替代NSC细胞功能治疗中枢系统损伤，具有很高的临床应用性。

摘要： 本发明提供了一种神经诱导培养基，它包含有Wnt信号激动剂（Wnt-signal agonist）、转化因子β信号抑制剂（TGFβ-signal inhibitor）及纤维母细胞生长因子信号激动剂（FGF-signal agonist）。使用该神经诱导培养基对万能干细胞进行培养，不仅可缩短万能干细胞分化为神经上皮细胞的分化时间，还可获得高纯度的神经上皮细胞而可高度表现神经标记，借此，可将该神经上皮细胞于临床上进一步分化为成熟神经细胞而应用于再生医学、筛选神经疾病药物等。

摘要： 我们公开了细菌抗原以及获得的抗体的用途。所得到的抗体可用于通过免疫组织化学来诊断肿瘤，以及用于药物与抗体的结合以在癌症疗法中应用。

摘要： 本发明的课题在于提供由多潜能干细胞有效地制备包含神经系统细胞或神经组织和非神经上皮组织的细胞团块的手段。细胞团块的制备方法，所述细胞团块包含1)神经系统细胞或神经组织及2)非神经上皮组织，所述方法包括下述步骤(1)及(2)：(1)第一步骤，将多潜能干细胞在Wnt信号转导途径抑制物质的存在下悬浮培养，使细胞的聚集体形成；(2)第二步骤，将第一步骤得到的聚集体在BMP信号转导途径作用物质的存在下悬浮培养，得到包含1)神经系统细胞或神经组织及2)非神经上皮组织的细胞团块。

摘要： 通过多能性神经上皮细胞的大脑内移植使行为和/或心理缺陷的校正的新方法成为可能。本发明包括细胞、细胞系、药物制剂、药物、产生和维持用于本发明的方法的细胞系的方法。

摘要： 本发明公开了一种快速直接定向诱导鼠胚胎干细胞分化为神经上皮细胞的方法，通过向贴壁培养的鼠胚胎干细胞团状克隆中加入含有dorsomorphin与noggin、SB431542和CHIR99021的诱导培养基，诱导鼠胚胎干细胞细胞形成玫瑰花状神经球；随后加入含有bFGF的第二阶段诱导培养基悬浮培养形成悬浮的神经球；最后将神经球消化成单细胞，然后用第三阶段诱导培养基贴壁培养形成具有较长期的自我增殖与更新的神经上皮细胞。本发明摒弃了传统的形成EB方法，缩短了分化时间，而且分化的效率达到了95％以上。本发明可快速诱导NE细胞替代NSC细胞功能治疗中枢系统损伤，具有很高的临床应用性。

摘要： 提供一种建立神经上皮干细胞的培养基、方法及其应用。所述培养基包括用于将多能干细胞诱导分化为初级神经上皮干细胞的分化培养基及用于使初级神经上皮干细胞扩增的扩增培养基。

摘要： 本发明提供了一种神经诱导培养基，它包含有Wnt信号激动剂（Wnt-signal agonist）、转化因子β信号抑制剂（TGFβ-signal inhibitor）及纤维母细胞生长因子信号激动剂（FGF-signal agonist）。使用该神经诱导培养基对万能干细胞进行培养，不仅可缩短万能干细胞分化为神经上皮细胞的分化时间，还可获得高纯度的神经上皮细胞而可高度表现神经标记，借此，可将该神经上皮细胞于临床上进一步分化为成熟神经细胞而应用于再生医学、筛选神经疾病药物等。

摘要： 我们公开了细菌抗原以及获得的抗体的用途。所得到的抗体可用于通过免疫组织化学来诊断肿瘤，以及用于药物与抗体的结合以在癌症疗法中应用。