Department of Neuropathology, Huashan Hospital, Fudan University, Shanghai, China.
Acta Neurochir (Wien). 2011 Sep;153(9):1769-80. doi: 10.1007/s00701-011-1052-z. Epub 2011 Jun 4.
Clear cell meningioma (CCM) is a rare histological variant of meningioma. CCM has a high recurrence rate and aggressiveness. In this study, we reviewed our experience in the treatment of the lesion.
Here we present a series of 15 patients with intracranial CCM. The clinical data were retrieved from the records of our Neurosurgery Department and the patients' prognoses were attained by clinic service and telephone. Immunohistochemistry for epithelial membrane antigen (EMA), vimentin, glial fibrillary acidic protein (GFAP), CD10, and S-100 was done, and the MIB-1 labeling index was calculated in all cases.
The 15 patients included eight males and seven females; the mean age was 34.8 years. The most frequent initial symptoms were headache and hearing loss. The most common location was the cerebellopontine angle (CPA) zone. Eleven patients had total removal and four patients underwent subtotal removal. Histological features of atypia were present in different proportions, from 6.7% to 100%, and six cases accorded with atypia. Three tumors showed brain invasion. EMA and vimentin were 100% positive, and CD10 was 100% negative. GFAP was 87% negative and S-100 was 93% negative. The mean follow-up period was 36.7 months. Three patients with brain invasion all recurred and five cases with atypia recurred. In 11 patients with total removal, six patients recurred. In four patients with subtotal removal, three patients recurred. Kaplan-Maier analysis showed that incomplete surgical resection was significantly associated with recurrence (p = 0.001). The MIB-1 labeling index for recurrence was 5.7 ± 2.7% versus 2.8 ± 1.5% for no recurrence (p = 0.036).
CCM is a rare subtype of meningioma, with a tendency to present in younger patients and a propensity to recur. Immunohistochemistry plays a vital role in differentiating CCM from other tumors. Brain invasion, atypia and MIB-1 labeling index are likely to predict the recurrence. The extent of resection might be connected with the prognosis.
透明细胞脑膜瘤（CCM）是脑膜瘤的一种罕见组织学亚型。CCM 具有较高的复发率和侵袭性。本研究回顾了我们在治疗该病变方面的经验。
我们在此介绍了 15 例颅内 CCM 患者。临床资料取自我们神经外科的记录，通过临床服务和电话获得患者的预后。对上皮膜抗原（EMA）、波形蛋白、胶质纤维酸性蛋白（GFAP）、CD10 和 S-100 进行免疫组织化学染色，并计算所有病例的 MIB-1 标记指数。
15 例患者中，男性 8 例，女性 7 例，平均年龄 34.8 岁。最常见的首发症状为头痛和听力下降。最常见的部位是桥小脑角（CPA）区。11 例患者行全切术，4 例行次全切除术。不同比例存在组织学异型性，范围为 6.7%~100%，其中 6 例符合异型性。3 例肿瘤有脑侵犯。EMA 和波形蛋白均为 100%阳性，CD10 为 100%阴性。GFAP 为 87%阴性，S-100 为 93%阴性。平均随访时间为 36.7 个月。3 例脑侵犯患者均复发，5 例异型性患者复发。11 例全切患者中，6 例复发。4 例次全切除患者中，3 例复发。Kaplan-Meier 分析显示，不完全手术切除与复发显著相关（p = 0.001）。复发患者的 MIB-1 标记指数为 5.7±2.7%，无复发患者为 2.8±1.5%（p = 0.036）。
CCM 是脑膜瘤的一种罕见亚型，倾向于发生在年轻患者，且易复发。免疫组织化学在鉴别 CCM 与其他肿瘤方面具有重要作用。脑侵犯、异型性和 MIB-1 标记指数可能预测复发。切除范围可能与预后有关。
