Jeibmann Astrid, Hasselblatt Martin, Gerss Joachim, Wrede Brigitte, Egensperger Rupert, Beschorner Rudi, Hans Volkmar H J, Rickert Christian H, Wolff Johannes E, Paulus Werner
Institute of Neuropathology, University Hospital Münster, Münster, Germany.
J Neuropathol Exp Neurol. 2006 Nov;65(11):1069-73. doi: 10.1097/01.jnen.0000240464.26005.90.
The prognostic significance of atypical histologic features in choroid plexus tumors remains uncertain. Therefore, a series of 164 choroid plexus tumors was evaluated for the presence of atypical histologic features, including mitotic activity, increased cellularity, nuclear pleomorphism, blurring of papillary growth pattern, and necrosis. The impact of histopathologic and clinical features on the probability of recurrence and survival was investigated. Twenty-four tumors displaying frank signs of malignancy were diagnosed as choroid plexus carcinoma according to World Health Organization criteria. Of 124 choroid plexus papillomas that had not received adjuvant treatment, 46 tumors (37%) displayed at least one atypical feature, including increased cellularity (n = 25 [20%]), mitotic activity (> or =2 mitoses per 10 high-power fields; n = 19 [15%]), nuclear pleomorphism (n = 16 [13%]), solid growth (n = 15 [12%]), and necrosis (n = 5 [4%]). Only one tumor-related death, but 10 recurrences, were observed on a mean observation time of 58 months. On univariate analysis, incomplete surgical resection (p = 0.03) and mitotic activity (p < 0.001) were the only clinicopathologic factors associated with recurrence. Using a multivariate model, an independent effect of mitotic activity on the probability of recurrence could be confirmed (p = 0.001). Because mitotic activity is the sole atypical histologic feature independently associated with recurrence, we propose to define atypical choroid plexus papilloma by mitotic activity (> or =2 mitoses per 10 high-power fields) corresponding to World Health Organization grade II, thus adjoining other intermediate tumor entities associated with increased mitotic activity such as atypical meningioma. Close follow up of patients harboring atypical choroid plexus papillomas may be warranted.
脉络丛肿瘤中非典型组织学特征的预后意义仍不明确。因此，我们对164例脉络丛肿瘤进行了评估，以确定是否存在非典型组织学特征，包括有丝分裂活性、细胞增多、核多形性、乳头状生长模式模糊和坏死。研究了组织病理学和临床特征对复发和生存概率的影响。根据世界卫生组织标准，24例表现出明显恶性迹象的肿瘤被诊断为脉络丛癌。在124例未接受辅助治疗的脉络丛乳头状瘤中，46例（37%）表现出至少一种非典型特征，包括细胞增多（n = 25 [20%]）、有丝分裂活性（每10个高倍视野有≥2个有丝分裂；n = 19 [15%]）、核多形性（n = 16 [13%]）、实性生长（n = 15 [12%]）和坏死（n = 5 [4%]）。在平均58个月的观察期内，仅观察到1例与肿瘤相关的死亡，但有10例复发。单因素分析显示，手术切除不完全（p = 0.03）和有丝分裂活性（p < 0.001）是与复发相关的仅有的临床病理因素。使用多变量模型，可以确认有丝分裂活性对复发概率有独立影响（p = 0.001）。由于有丝分裂活性是唯一与复发独立相关的非典型组织学特征，我们建议根据对应于世界卫生组织II级的有丝分裂活性（每10个高倍视野有≥2个有丝分裂）来定义非典型脉络丛乳头状瘤，从而将其他与有丝分裂活性增加相关的中间肿瘤实体（如非典型脑膜瘤）包括在内。对于患有非典型脉络丛乳头状瘤的患者，可能需要密切随访。
