摘要
目的探讨眼眶内视神经脑膜瘤影像学和组织病理形态学特点以及波形蛋白（Vimentin）、细胞角蛋白（CK）、S-100、上皮膜抗原（EMA）抗体在瘤细胞内的表达情况。方法回顾性系列病例研究。收集1989年1月至2010年12月在四川大学华西医院眼科住院并经手术后病理证实、病例资料完整的48例眼眶内视神经脑膜瘤患者的临床资料。均行CT扫描，17例行MRI扫描。均行组织病理学检查，包括石蜡包埋、切片、HE染色、读片和显微照相。21例用免疫组织化学法检测肿瘤中Vimentin、CK、S-100、EMA的表达情况。结果CT影像学特点：39例眼眶内视神经脑膜瘤大小不等，边界较清楚，密度不均，其中26例肿瘤充满眼眶，特别是眶尖，“黑三角”消失。3例视神经增粗钙化，可见双轨征，3例视神经肿块近眼球后壁，3例肿块位于眼眶周围。根据组织病理形态学检查结果，将肿瘤分为上皮型35例，混合型8例，纤维型3例和血管型2例。在17例MRI检查中，13例见肿瘤靠后几乎充满眼眶，5例显示肿瘤侵犯视交叉、到达颅内。免疫组织化学染色结果显示，Vimentin阳性率为95％（21例）、EMA阳性率为70％（15例）、CK阳性率为45％（9例）以及S-100阳性率25％（5例）。结论眼眶内视神经脑膜瘤的CT、MRI影像学主要特点是视神经增粗、肿瘤样扩大，多数病例肿瘤达眼眶尖，密度不均，可能出现钙化。组织病理学特点为大部分病例为上皮型。免疫组织化学染色结果显示，Vimentin、EMA阳性比例大。
Objective To determine the characteristics of optic nerve meningiomas in medicalimageology （including CT and MRI ）, histopathology and itnmunohistochemical expression of Vimentin,CK,S-100,EMA in tumor cells. Methods This was a retrospective study on a serial of clinical cases. Forty-eight cases were collected from the past 21 years at the Department of Ophthalmology, West China Hospital, Sichuan University. All the cases underwent surgery and were confirmed as optic nerve meningiomas by histopathological test, including paraffin imbedded sectioning and HE staining. In addition, all the cases had medical records on CT and 17 cases had MIR scan. Immunohistochemical staining for VIMENTIN,CK, S-100, EMA was performed in the 21 cases. Results Characteristics of the CT scan include that, in 39 cases, among them 26 cases the tumors filled in the orbit especially at the orbital apex, which led to the disappearance of the black triangle. Three cases showed enlargement and calcification of optic nerve and therefore train track sign was seen. Three cases showed that the masses of optic nerve were close to the globe and another three cases showed that the masses were located in the peripheral orbit. Thirteen of 17 cases MRI disclosed the big orbital tumors and 5 cases could better show tumor extension to optic cross or intracranium. Histopathological tests demonstrated meningothelial or syncytial type in 39 cases, transitional or mixing type in 8 cases, fiber or fibroblast type in 3 cases and vascular type in 2 cases. Immunohistochemistry study verified the positive staining rate of VIMENTIN as 90.5% （21 cases） , EMA 66.7% （ 15 cases）, CK 42.8% （9 cases） and S-100 23.8% （5 cases）, respectively. Conclusions Characteristics of CT and MRI include enlargement and tumor-like expansion of optic nerve. Most of the tumors reach to orbital apex and show uneven density. Calcification may occur in the tumor. The main pathological type of the tumors is meningothelial. Positive immunohistochemiscal staining for VIMENT
出处
《中华眼科杂志》
CAS
CSCD
北大核心
2013年第6期526-530,共5页
Chinese Journal of Ophthalmology
基金
国家自然科学基金（30371517）
关键词
眶肿瘤
视神经肿瘤
脑膜瘤
体层摄影术
x线计算机
磁共振成像
免疫组织化学
Orbital neoplasms
Optic nerve neoplasms
Meningioma
Tomography, x-raycomputed
Magnetic resonance imaging
Immunohistochemistry
