摘要
目的探讨术中快速病理诊断为小圆细胞恶性肿瘤的小脑幕上肿瘤的诊断和治疗。方法回顾性分析2011年1月至2017年12月南方医科大学南方医院神经外科收治的36例术中冰冻病理学诊断为小圆细胞恶性肿瘤的小脑幕上肿瘤患者的临床资料。所有患者均按照胶质瘤的手术原则采取肿瘤完全切除术治疗。术后复查头颅MRI,采用容积定量分析方法判断肿瘤的切除程度,分为完全切除、次全切除及部分切除。对所有患者定期行门诊随访,复查头颅MRI,以判断肿瘤的复发情况。结果36例患者术后复查头颅MRI显示,31例(86.1%)为完全切除,5例(13.9%)为次全切除。36例患者的病理学结果为,原发性中枢神经系统淋巴瘤10例,胶质母细胞瘤6例,中枢神经细胞瘤5例,原始神经外胚层肿瘤3例,转移瘤、松果体细胞瘤、室管膜母细胞瘤、世界卫生组织(WHO)Ⅱ级胶质瘤各2例、垂体腺瘤、血管周细胞瘤、嗅神经母细胞瘤、促纤维组织增生性小圆细胞肿瘤各1例。术前经头颅MRI初步诊断的33例患者中,8例(24.2%)的病理学结果与术前诊断一致,其中4例为淋巴瘤、1例为中枢神经细胞瘤、1例为原始神经外胚层肿瘤、1例为血管周细胞瘤、1例为转移瘤。36例患者的随访时间为(28.9±8.1)个月(6~70个月)。随访期间,36例患者中,26例(72.2%)复发。结论术中快速病理诊断为小圆细胞恶性肿瘤的小脑幕上肿瘤,术后病理结果多样;手术时在保证安全的前提下最大范围切除,可提高临床疗效。
Objective To explore the diagnosis and treatment of supratentorial tumors with small round cell malignancies diagnosed by intraoperative rapid pathology.Methods A retrospective analysis was conducted on the clinical data of 36 patients with supratentorial tumors diagnosed as small round cell malignant tumors by intraoperative frozen pathology at Department of Neurosurgery,Nanfang Hospital,Southern Medical University from January 2011 to December 2017.All patients were treated with complete tumor resection according to the principle of glioma operation.After the operation,the MRI of the head was reexamined,and the volume quantitative analysis was used to determine the degree of tumor resection,which was divided into complete resection,subtotal resection and partial resection.All patients were followed up regularly in outpatient department,and MRI was reexamined to explore the recurrence of tumor.Results MRI of 36 patients after operation showed that 31 patients(86.1%)had complete resection and 5 patients(13.9%)had subtotal resection.The results of pathological diagnosis were as follows:primary central nervous system lymphoma(10 cases),glioblastoma(6 cases),central neurocytoma(5 cases),primitive neuroectodermal tumors(3 cases),brain metastasis tumor(2 cases),pineal cell tumors(2 cases),ependymoblastoma(2 cases),World Health Organization(WHO)gradeⅡglioma(2 cases),pituitary adenoma(1 case),periangioblastoma(1 case),olfactory neuroblastoma(1 case)and desmoplastic small round cell tumor(1 case).Among the 33 patients diagnosed by MRI before operation,8(24.2%)had the same pathological results with preoperative diagnosis,including 4 cases of lymphoma,1 case of central neurocytoma,1 case of primitive neuroectodermal tumor,1 case of hemangioblastoma and 1 case of metastasis.The follow-up duration of 36 patients was 28.9±8.1 months and ranged from 6 to 70 months.During the follow-up period,26 out of 36 patients(72.2%)relapsed.Conclusions The supratentorial tumors with small round cell malignant tumor diagnosed by rapid pathology during operation should be resected in the maximal range under the premise of safety,the pathological results are various and its therapeutic effect seems relatively good.
作者
李志勇
易国仲
黄广龙
张喜安
宋烨
王海
方陆雄
刘亚伟
潘军
漆松涛
Li Zhiyong;Yi Guozhong;Huang Guanglong;Zhang Xi′an;Song Ye;Wang Hai;Fang Luxiong;Liu Yawei;Pan Jun;Qi Songtao(Department of Neurosurgery,Nanfang Hospital,Southern Medical University,Guangzhou 510515,China)
出处
《中华神经外科杂志》
CSCD
北大核心
2020年第1期21-25,共5页
Chinese Journal of Neurosurgery
基金
国家自然科学基金青年科学基金(81802505)。
关键词
幕上肿瘤
病理学
治疗结果
手术中
小圆细胞恶性肿瘤
Supratentorial tumor
Pathology
Treatment outcome
In operation
Small round cell tumor
