摘要
目的 探讨上皮样胶质母细胞瘤(eGBM)的诊断方式、临床特点、治疗方法。方法 回顾性分析2012年1月~2020年1月郑州大学第一附属医院收治的13例eGBM患者的资料,其中男3例,女10例,年龄4~42岁,平均(19.4±12.5)岁。病变部位:额叶4例,枕叶3例,颞叶3例,侧脑室2例,胼胝体1例,患者均行显微手术治疗。描述肿瘤临床特征及影像、病理特点,鉴别分析与其相混淆病变,随访患者治疗效果及预后情况。结果 eGBM临床表现多为因颅内占位而引起的头痛、呕吐、视力模糊等症状;影像学检查具有一定的特征性:瘤体实性部分T1WI为低/稍低信号,T2WI为高信号,增强扫描呈不均匀强化,发生部位表浅,囊变、坏死、出血多,边界清楚,常累及邻近脑膜且伴周围组织水肿;11例术中全切,2例行大部分切除,12例术后同步放、化疗。患者中位生存期为21个月(至末次随访仍有4例患者健在)。术后3例患者出现复发。免疫组化显示CK、GFAP、S-100阳性率较高和Ki-67增殖指数的高表达;分子生物学方面常表达INI-1和B-raf基因V600E突变。结论 eGBM的临床特点无特异性,一般为颅内占位引起的颅高压症状,其诊断依赖于放射学、组织学和遗传学的综合分析,显微手术切除和同步放化疗仍是一线治疗方式。
Objective To investigate the diagnosis method, clinical characteristics and treatment of epithelioid glioblastoma(eGBM). Methods The data of 13 patients with eGBM admitted to the First Affiliated Hospital of Zhengzhou University from January 2012 to January 2020 were retrospectively analyzed, including 3 males and 10 females, aged(19.4±12.5)years(range:4-42 years).The lesions were frontal lobe in 4 cases,occipital lobe in 3 cases,temporal lobe in 3 cases,lateral ventricle in 2 cases,and corpus callosum in 1 case.The clinical features,imaging and pathological features of the tumor were described. The confused lesions were differentiated and analyzed,and the therapeutic effect and prognosis of the patients were followed up. Results The clinical manifestations of eGBM were mainly headache, vomiting, blurred vision and other symptoms caused by intracranial mass.Imaging examination had certain characteristics:The solid part of the tumor was hypointense/slightly hypointense on T1WI,hyperintense on T2WI, heterogeneous enhancement on enhanced scan, the occurrence site was superficial,with cystic degeneration, necrosis, bleeding, clear boundary,often involving the adjacent meninges and with surrounding tissue edema.11 cases underwent total resection,2 cases underwent major resection, and 12 cases underwent postoperative concurrent radiotherapy and chemotherapy.The median survival time was 21 months(4 patients remained alive until the last follow-up).Postoperative recurrence occurred in 3 patients.Immunohistochemistry showed a high positive rate of CK,GFAP,and S-100 and a high expression of Ki-67 proliferation index.INI-1 and B-raf gene V600E mutations were often expressed in terms of molecular biology. Conclusion The clinical features of eGBM are non-specific,generally intracranial hypertension caused by intracranial mass. The diagnosis depends on a comprehensive analysis of radiology, histology and genetics. Microsurgical resection and concurrent radiotherapy and chemotherapy are still the first-line treatment.
作者
孔腾霄
张栋韬
袁善鹏
高鹏
焦贺男
李雪元
闫东明
KONG Tengxiao;ZHANG Dongtao;YUAN Shanpeng;GAO Peng;JIAO He′nan;LI Xueyuan;YAN Dongming(Department of Neurosurgery,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)
出处
《中国现代医生》
2022年第16期10-14,共5页
China Modern Doctor
