富于淋巴细胞-浆细胞型脑膜瘤：我们19例病例的经验及系统的文献综述
Lymphoplasmacyte-rich meningioma: our experience with 19 cases and a systematic literature review.
作者信息
Zhu Hong-Da, Xie Qing, Gong Ye, Mao Ying, Zhong Ping, Hang Feng-Ping, Chen Hong, Zheng Ming-Zhe, Tang Hai-Liang, Wang Dai-Jun, Chen Xian-Cheng, Zhou Liang-Fu
机构信息
Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University Shanghai, China.
出版信息
Int J Clin Exp Med. 2013 Aug 1;6(7):504-15. Print 2013.
OBJECTIVE
To investigate the clinicopathological characteristics, prognosis, pathology, and differential diagnosis of LPM by analyzing our experience and reviewed relevant literature. We also postulated the necessity of postoperative adjuvant therapy.
METHODS
19 patients with LPM underwent surgical treatment from 2007 through 2010 in our department. The clinical charts of the patients, including surgical, histological, and follow-up records, as well as imaging studies, were analyzed retrospectively. Other 43 cases searched from the literature were also included, so that 62 LPM cases were summarized and reviewed together.
RESULTS
The summarized 62 patients comprised 30 males and 31 females aged 9 years to 79 years (40.7±18.3 years). The most common locations were convexity, skull base, para-sagittal and cervical canal. Multiple or diffuse lesions were found in 8 cases. There were 13 patients had peripheral blood abnormalities (21%). One-third of the cases had moderate to severe peritumoral brain edema. Thirty-eight patients had total resection, 12 patients not specified while 12 received subtotal resection or only biopsy. MIB-1 was available in 24 cases and a third of them were higher than 3%. Follow-up more than 3 year was only completed in 19/62 cases. Seven cases suffered recurrence and two of them died after 2 years of operation.
CONCLUSION
LPM is a very rare benign variant of intracranial meningioma. Both lesions and hematological abnormalities have a predilection for younger individuals. Preoperative diagnosis of this subtype of meningioma is still difficult. Surgical resection is the primary treatment option, and supportive care for those not totally removed is very important, because the recurrence rate for this subtype is rather low. However, the massive infiltration of lymphocytes and plasma cells in LPMs are still controversial and the long-term follow-ups are needed. Radiotherapy is not recommended, and hormonal or immune-inhibitor therapy might be helpful.
目的
通过分析我们的经验并回顾相关文献，探讨淋巴细胞性垂体瘤（LPM）的临床病理特征、预后、病理及鉴别诊断。我们还提出了术后辅助治疗的必要性。
方法
2007年至2010年期间，我科对19例LPM患者进行了手术治疗。回顾性分析了患者的临床病历，包括手术、组织学和随访记录以及影像学研究。还纳入了从文献中检索到的其他43例病例，从而对62例LPM病例进行了汇总和综述。
结果
汇总的62例患者中，男性30例，女性31例，年龄9岁至79岁（40.7±18.3岁）。最常见的部位是凸面、颅底、矢状窦旁和椎管。8例发现多发或弥漫性病变。13例患者有外周血异常（21%）。三分之一的病例有中度至重度瘤周脑水肿。38例患者行全切除，12例未提及切除情况，12例接受次全切除或仅活检。24例有MIB-1数据，其中三分之一高于3%。62例中仅19例完成了3年以上的随访。7例复发，其中2例术后2年死亡。
结论
LPM是颅内脑膜瘤一种非常罕见的良性变异型。病变和血液学异常均好发于年轻人。该亚型脑膜瘤的术前诊断仍很困难。手术切除是主要的治疗选择，对于未完全切除的患者，支持治疗非常重要，因为该亚型的复发率相当低。然而，LPM中淋巴细胞和浆细胞的大量浸润仍存在争议，需要长期随访。不推荐放疗，激素或免疫抑制剂治疗可能有帮助。
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