ObjectiveTo review the clinical records of patients with central nervous system (CNS) embryonal tumors, not otherwise specified (NOS); and summarize their clinical features, diagnosis, and treatment.MethodWe reviewed the data of patients with intracranial tumors admitted to Department of Neurosurgery of West China Hospital, Sichuan University from January 2014 to December 2016, and retrospectively analyzed the clinical features, diagnosis, and treatment of seven patients with CNS embryonal tumors, NOS.ResultsThere were 4 males and 3 females, and the mean age was 25.4 years old. The tumor was located in cerebral hemisphere in 5 patients, and in third ventricle in 2. Clinical presentation included headache, nausea, and vomiting due to intracranial hypertension, and focal neurological signs. All patients underwent craniotomy for tumor resection and postoperative pathology confirmed CNS embryonal tumor, NOS. The patients were followed up for 6 months to 3 years, and 2 patients died during follow-up.ConclusionsCNS embryonal tumor, NOS is malignant intracranial lesion, and has been enlisted as a separate entity under classification of CNS embryonal tumors. It has its unique radiological features, including rare occurrence of perilesional edema, cystic changes, and clear demarcation. Through comprehensive treatment including surgical resection, chemotherapy, and radiation therapy, patients can enjoy prolonged survival and improved quality of life.
目的:探討兒童顱骨血管瘤的臨床特點和手術治療。方法:報告自2002年1月至2008年12月我院收治的3例兒童顱骨血管瘤病例,結合相關文獻分析該疾病的臨床表現,影像學特征,病理特點及治療方法。結果:兒童顱骨血管瘤臨床上極為罕見。影像學檢查顯示顱骨呈蜂窩狀溶骨性改變并向顱內外生長。病理切片顯示骨結構異常,并伴有大小不等異常血管增生及血栓形成。結論:顱骨血管瘤是一種侵蝕顱骨內外板的破壞性疾病。手術應早期進行,完整切除后,患者預后良好。
目的：探討松果體區腫瘤的治療策略。方法:我院自2003年12月至2007年12月收治的58例松果體區腫瘤，按腫瘤標志物甲胎蛋白（AFP）和人β促絨膜性腺激素（hCG-β）將其分為標志物增高組和正常組，回顧分析兩組臨床資料和治療體會。結果:腫瘤標志物正常組36例，其中27例行手術切除腫瘤，9例行伽馬刀治療（其中5例行伽馬刀加腦室腹腔分流治療）。術后4例因病理報告示生殖細胞瘤行伽馬刀補充治療，3例因梗阻性腦積水行腦室腹腔分流。增高組22例，均選用伽馬刀治療（其中17例合并梗阻性腦積水者行伽馬刀加腦室腹腔分流）。治療后3例因癥狀緩解不佳行手術切除腫瘤術。手術病例中24例采用經胼胝體入路，4例經枕部小腦幕入路，2例經幕下小腦上入路。手術全切24例，次全切5例，部分切除1例，術后住院期內死亡者1例。病理診斷:生殖細胞瘤14例，畸胎瘤5例，中樞神經細胞瘤4例，室管膜瘤2例，表皮樣囊腫2例，腦膜瘤1例，膠質瘤1例，皮樣囊腫1例。放射外科治療病例中28例術后3個月臨床癥狀明顯改善，4例隨訪期內腫瘤無明顯變化，3例腫瘤增大。2例放療后出現鞍區轉移。結論:松果體區腫瘤組織類型多樣，應盡可能先明確腫瘤性質后選擇合理治療策略。
目的 探討水通道蛋白4（AQP4）在腦膠質瘤性腦水腫的分子調節機制及與血管內皮生長因子（VEGF）的關系。 方法 收集2007年10月-2008年6月間65例腦膠質瘤患者手術切除新鮮腫瘤標本（膠質瘤Ⅰ級6例、Ⅱ級18例、Ⅲ級11例、Ⅳ級30例）。應用免疫熒光細胞化學方法檢測腫瘤組織中AQP4蛋白和VEGF蛋白的陽性表達情況，并分析AQP4和VEGF的表達差異與關系。 結果 免疫熒光細胞化學法染色顯示，AQP4蛋白在正常腦組織中主要表達于細胞膜表面，胞漿和細胞核著色較淺。在膠質瘤細胞內，AQP4廣泛分布于胞漿內；腫瘤中AQP4表達和VEGF呈正相關（r=0.877，P=0.000）。 結論 在膠質瘤性腦水腫中，AQP4在膠質瘤細胞內主要分布于胞漿內，且與VEGF呈明顯正相關。
【摘要】 目的 探討成人幕上低級別膠質瘤（WHO Ⅱ級）患者術后生活質量的影響因素。 方法 回顧性分析2008年10月—2010年5月經手術切除病變、術后病理證實為低級別膠質瘤的115例患者臨床資料，術后隨訪6~24個月。以患者年齡、性別、主要臨床癥狀、病變部位、病變大小及病理結果為自變量，以術后Karnofsky評分（KPS）改善為因變量，采用Logistic回歸分析研究相關影響因素。采用秩和檢驗比較不同組間KPS差異。 結果 隨訪至術后6個月，患者年齡、病變大小、病變部位、切除范圍以及是否有癲癇史在KPS比較中，其結果有統計學意義（Plt;0.05）。隨訪至術后12個月，切除范圍和癲癇史對KPS評分已無影響（Pgt;0.05）。病理類型、術前是否存在神經功能障礙與術后KPS改善在單因素和多因素比較中無統計學意義。 結論 患者年齡≤50歲、術前有癲癇史、腫瘤直徑≤4 cm、病變表淺、腫瘤全切除的患者術后KPS改善好于年齡gt;50歲、術前無癲癇史、腫瘤直徑gt;4 cm、病變深在、腫瘤次全切除的患者。患者術前是否存在神經功能障礙和病理類型與術后生活質量是否改善無明顯關系。復發也是影響患者術后KPS改善的因素。【Abstract】 Objective To assess the quality of life in adults with surgically managed cerebral supratentorial low grade glioma (WHO grade Ⅱ) and the relevant factors. Methods We retrospectively analyzed the clinical data of 115 patients with histologically proven supratentorial low grade glioma enrolled at West China Hosptial from October 2008 to May 2010. Follow-up lasted for 6 to 24 months after operation. Logisitc regression analysis is used to test the relevant factors with age, gender, main clinical manifestations, lesion location, lesion size and pathological results as the independent variables, and Kamofsky postoperative scale (KPS) scores as dependent variable. KPS scores of different groups were analyzed using the rank test. Results After 6 months of follow-up, we found that age, size, location, extent of surgical excision and eplispy history showed a statistical significance in KPS comparison (Plt;0.05). Till the 12th month in the follow-up, the extent of surgical excision and eplispy history were not statistically significant any more (Pgt;0.05). Histology type and neurological deficit had no relationship with KPS improvement in both single factor analysis and multivariate analysis. Conclusions Patients with an age older than 50 years, preoperative epilepsy history, the largest diameter of the tumor less than 4 cm, shallow lesions, and complete tumor resection have a better KPS improvement after operation than those with corresponding opposite conditions. There is no obvious relationship between histology type, neurologic deficits and KPS improvement after operation. Recurrence is also a factor influencing KPS improvement after operation.
ObjectiveTo provide reference for further treatment by analyzing the relationship between mutant genes of breast cancer and histological classification and molecular typing of breast cancer.MethodsRetrospectively collectted the pathological specimens of 46 breast cancer patients who treated by the Dongguan Maternal and Child Health Hospital and the Dongguan Houjie Hospital between February 2016 and August 2017 without chemotherapy. Among the selected 46 breast cancer patients, we detected tumor tissue estrogen receptor (ER)/ pregnancy hormone receptor (PR)/human epidermal growth factor receptor-2 (HER-2) status by immunohistochemistry and classified the pathological tissue section. By using multiple PCR techniques, we detected 207 hot mutation regions of the 50 extended tumor-related genes on the semiconductor sequencing platform.ResultsThere were 8 cases of grade Ⅰ, 18 cases of grade Ⅱ, 20 cases of grade Ⅲ in 46 breast cancer patients according to histological grade. Of the 46 cases, there were 23 cases of Luminal B, 9 cases of Luminal A, 9 cases of HER-2 (+), 5 cases of type besal-like according to ER/PR/HER-2 expression status. Moreover, we found that there were 33 gene locus mutations of 8 genes, including AKT1, APC, BRAF, CDKN2A, KRAS, PTEN, PIK3CA, and TP53. Among of them, the mutation of PIK3CA gene took the most of 24 cases, followed by TP53 (18 cases), 2 cases of CDKN2A gene mutation, and 1 case in the remaining four types of genes respectively. we found that the gene mutations of breast cancer were not related to the histological classification and molecular type (P>0.05), the PIK3CA gene mutation was related to the histological classification of breast cancer, the lower the histological classification level, the higher PIK3CA gene mutation rate (P<0.05). TP53 gene mutation was not related to histological grading and molecular type (P>0.05).Conclusions The PIK3CA gene mutation rate in patients with histological grading Ⅰ level increased significantly. The combination of PIK3CA gene mutation and histological grading of breast cancer may become a molecular biological indicator to judge the degree of malignancy and prognosis of breast cancer.
目的 探討經胼胝體-穹窿間入路切除第三腦室腫瘤術后，近期下丘腦反應的發生情況及相關因素，為防治第三腦室腫瘤術后下丘腦反應提供參考。 方法 回顧分析2003年1月－2008年12月經胼胝體-穹窿間入路切除的78例第三腦室腫瘤患者手術后近期（1個月內）下丘腦反應的發生情況，并將其按照腫瘤部位、病理性質、大小、血供、手術切除程度進行分類統計，用SPSS 13.0軟件logistic 回歸分析影響這些并發癥的因素。 結果 78例術后下丘腦反應37例，發生率47.4%；死亡5例，下丘腦反應病死率為13.5%（5/37）。其中電解質糖代謝紊亂33例（42.3%），尿崩癥27例（34.6%），激素水平低下16例（20.5%），高熱6例（7.7%）。好轉痊愈率：激素水平低下43.7%，其余均＞70%。第三腦室前部顱咽管瘤術后最容易發生下丘腦反應（P＜0.05）。 結論 經胼胝體-穹窿間入路切除第三腦室腫瘤術后近期存在程度不同的下丘腦反應，其發生與腫瘤部位、病理性質有密切關系。經積極治療，大部分下丘腦反應能在術后1個月內好轉甚至痊愈。