Badhe Prerna B, Chauhan Pritika P, Mehta Nishaki K
Department of Pathology, Seth G. S. Medical College and KEM Hospital, Parel, Mumbai, India.
Indian J Cancer. 2004 Oct-Dec;41(4):170-4.
Brainstem tumors represent 10% of central nervous system tumors, accounting for 30% of pediatric posterior fossa tumors.
The aim of this study was to clinicopathologically correlate 45 cases of brain stem gliomas and determine the occurrence and prognostic significance of p53 expression.
45 cases of brain stem gliomas encountered during a 19-year period. 30 were diagnosed by surgical biopsy and 15 at autopsy. In 25 cases p53 immunohistochemistry (Avidin Biotinylated technique) was performed. The WHO brain tumor classification and Stroink's CT classification were applied.
Chi square test.
51 % of gliomas were observed in the first decade of life. The female to male ratio was 1.04: 1. The commonest presenting features were cranial nerve palsies (33%) and cerebellar signs (29.8%). 55.55% of cases were located in the pons, 31.01% in the medulla and 13.33% in the midbrain. Diffuse astrocytomas were seen in 40 cases (5% were Grade I, 47.5%Grade II, 32.5% Grade III and 15% Grade IV) and pilocytic astrocytomas in 5 cases. Grade IV patients had 2- 3 mitoses /10 high power fields and had a poorer survival rate. Grade II astrocytomas were treated with excision and radiotherapy, while grade III and IV tumors were treated with radiotherapy and chemotherapy (CCNU). Improvement was noted in 20% of patients postoperatively. The outcome was better in patients who were treated surgically. p53 is a frequently mutated gene in brain stem astrocytomas. It was found in 50 % of glioblastoma multiforme, 28.57% of grade III astrocytoma and 12.5% of grade II astrocytoma, while grade 1 astrocytomas failed to express p53 protein. p53 positivity was more in high grade lesions, decreasing significantly in lower grade lesions.
脑干肿瘤占中枢神经系统肿瘤的10%,占儿童后颅窝肿瘤的30%。
本研究旨在对45例脑干胶质瘤进行临床病理相关分析,并确定p53表达的发生率及其预后意义。
19年间收治的45例脑干胶质瘤患者。30例经手术活检确诊,15例经尸检确诊。对其中25例进行了p53免疫组化(抗生物素蛋白-生物素化技术)检测。采用世界卫生组织脑肿瘤分类和斯特罗因克CT分类。
卡方检验。
51%的胶质瘤发生在生命的第一个十年。男女比例为1.04:1。最常见的临床表现为颅神经麻痹(33%)和小脑体征(29.8%)。55.55%的病例位于脑桥,31.01%位于延髓,13.33%位于中脑。40例为弥漫性星形细胞瘤(5%为Ⅰ级,47.5%为Ⅱ级,32.5%为Ⅲ级,15%为Ⅳ级),5例为毛细胞型星形细胞瘤。Ⅳ级患者每10个高倍视野有2 - 3个有丝分裂,生存率较低。Ⅱ级星形细胞瘤采用手术切除和放疗,Ⅲ级和Ⅳ级肿瘤采用放疗和化疗(洛莫司汀)。20%的患者术后病情有所改善。手术治疗的患者预后较好。p53是脑干星形细胞瘤中常见的突变基因。在50%的多形性胶质母细胞瘤、28.57%的Ⅲ级星形细胞瘤和12.5%的Ⅱ级星形细胞瘤中发现该基因,而Ⅰ级星形细胞瘤未表达p53蛋白。p53阳性在高级别病变中较多,在低级别病变中显著减少。