85例髓母细胞瘤临床病理学分析

摘要

Objective To investigate the clinicopathological features and the major risk factors affecting the prognosis of patients with medulloblastoma.Methods The clinicopathological features of 85 cases of medulloblastoma were analyzed.Immunohistochemical study was carried out and literature was reviewed to analyze the major risk factors of prognosis.Results There were 49 males and 36 females.The average age of patients was (9.35±1.18)years old.The tumor was located in the cerebellum with 75 cases (in cerebel-lar hemisphere with 5 9 cases,and in cerebellar vermis with 1 6 cases),in the spinal cord with 5 cases,in the fourth ventrical with 1 case,temporal lobe with 1 cases,in frontal lobe with 1 case,in occipital lobe with 1 case and in midbrain with 1 case.The clinical symptoms of these cases were dizziness,headache, vomiting,optic disc edema and ataxia.Immunohistochemically,the tumor cell was positive for Syn, GFAP,NF,CD99,β-catenin,but negative for Vimentin,CK,Neu-N,EMA.The proliferation index of Ki-6 7 was very high.Conclusion Medulloblastoma is common among children with poor prognosis.Immunohisto-chemical Expressions of Ki-6 7 andβ-catenin are of certain reference value to its diagnosis and differential diagnosis.%目的：探讨髓母细胞瘤临床病理学特征及其影响患者预后的主要危险因素。方法收集85例髓母细胞瘤患者的临床病理学资料，观察其组织病理学及免疫学表型特征，分析其临床特点及影响患者预后的相关危险因素。结果85例髓母细胞瘤患者中男性49例，女性36例，平均发病年龄（9．35±1．18）岁。75例患者病变位于小脑（其中59例位于小脑半球，16例位于小脑蚓部），10例分别位于脊髓（5例）、第四脑室（1例）、大脑颞叶（1例）、大脑额叶（1例）、大脑枕叶（1例）、中脑（1例）。临床表现主要为颅内压增高、共济失调及患侧肢体运动障碍等，部分病人表现为言语不清、记忆力下降及肢体感觉麻木等。免疫组织化学检查：突触素（Syn）阳性表达率为64％，β连环蛋白（β-catenin）阳性表达率为45％，胶质纤维酸性蛋白（GFAP）阳性表达率为50％；NF、CD99肿瘤细胞散在或弱阳性表达；Vimentin、CK、Neu-N、EMA肿瘤细胞呈阴性表达；肿瘤细胞Ki-67增殖指数较高，约为60％。结论髓母细胞瘤儿童多发，预后不良，β-catenin和Ki-67免疫组化染色对其诊断与鉴别诊断有一定参考价值，可能成为髓母细胞瘤判断预后的重要指标。