[成年患者的颅内室管膜瘤。诊断及组织学预后因素]

[Intracranial ependymomas in adult patients. Diagnosis and histological prognostic factors].

作者信息

Figarella-Branger D, Metellus P, Barrié M, Maues de Paula A, Fernandez C, Polivka M, Vital A, Labrousse F, Vignaud J-M, Laquerrière A, Rousselet M-C, Lacroix C, Saikali S, Chapon F, Gontier M-F, Chrétien F, Babin P, Rigau V, Vandenbos F, Peoc'h M, Kujas M, Chinot O, Gouvernet J, Giorgi R, Guyotat J, Jouvet A

机构信息

Service d'anatomie pathologique et de neuropathologie, hôpital de la Timone, 264, rue Saint-Pierre, 13385 Marseille cedex 05, France.

出版信息

Neurochirurgie. 2007 Jun;53(2-3 Pt 1):76-84. doi: 10.1016/j.neuchi.2006.11.007.

DOI:10.1016/j.neuchi.2006.11.007

PMID:17445840

Abstract

BACKGROUND

Intracranial ependymomas are rare in adults and histopathological prognostic factors are poorly determined.

PURPOSE

A retrospective multicentric study was conducted in France in order to assess the prognostic value of histology.

MATERIAL

Between 1990 and 2004, 216 adult patients with newly diagnosed ependymomas were treated in 19 French centers. Eligibility required institutional histopathological confirmation of an ependymoma and available clinical history and MRI features (see comparison paper).

METHODS

Histological preparations and one paraffin embedded block from each patient were sent to Pr D. Figarella-Branger in Marseille. Central review by four neuropathologists (D. Figarella-Branger, A. Maues de Paula, C. Fernandez and A. Jouvet) was performed. Specimens for which all pathologists agreed with the histological diagnosis of ependymomas were included, whereas cases for which all disagree were excluded and reclassified. In the event of doubt and/or discrepancies between pathologists immunostaining was performed in order to reach a consensus diagnosis. Diagnostic of ependymomas was confirmed in 121 cases (56%). In theses cases, ependymomas were classified according to the WHO system (subtype and grade). The potential prognostic value (overall survival OS and disease free survival DFS) of the following histological parameters was examined: perivascular pseudorosettes, ependymal rosettes, hyalinized vessels, mitotic index, microvascular proliferation, necrosis, area of increased cellularity, nuclear atypia, brain invasion and Mib-1 labelling index.

RESULTS

Among the 121 ependymomas, 88 were grade II (47 classic, 17 cellular, 2 papillar, 6 clear cells and 16 tanicytic) and 33 grade III. WHO grading, occurrence of microvascular proliferation, necrosis, nuclear atypia and high proliferative index were correlated with both OS and DFS. Moreover, quantification of certain parameters enabled a reproducible grading system correlated with both OS and DFS.

摘要

背景

颅内室管膜瘤在成人中罕见，组织病理学预后因素尚未明确。

目的

在法国进行一项回顾性多中心研究，以评估组织学的预后价值。

材料

1990年至2004年间，19个法国中心治疗了216例新诊断的成人室管膜瘤患者。入选要求机构对室管膜瘤进行组织病理学确认，并提供可用的临床病史和MRI特征（见比较论文）。

方法

将每位患者的组织学标本和一块石蜡包埋块送至马赛的D. Figarella-Branger教授处。由四位神经病理学家（D. Figarella-Branger、A. Maues de Paula、C. Fernandez和A. Jouvet）进行集中评审。所有病理学家均同意室管膜瘤组织学诊断的标本被纳入，而所有病理学家均不同意的病例被排除并重新分类。若病理学家之间存在疑问和/或差异，则进行免疫染色以达成共识诊断。121例（56%）病例确诊为室管膜瘤。在这些病例中，室管膜瘤根据世界卫生组织系统进行分类（亚型和分级）。研究了以下组织学参数的潜在预后价值（总生存期OS和无病生存期DFS）：血管周围假菊形团、室管膜菊形团、玻璃样变血管、有丝分裂指数、微血管增生、坏死、细胞增多区域、核异型性、脑侵袭和Mib-1标记指数。