Chunhui Liu, Chuzhong Li, Zhenye Li, Yilin Sun, Yazhuo Zhang
Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
World Neurosurg. 2016 Apr;88:690.e1-690.e5. doi: 10.1016/j.wneu.2015.11.031. Epub 2015 Nov 30.
Craniopharyngioma is a rare benign intracranial neoplasm that is successfully managed with surgery or adjuvant radiotherapy. The malignant transformation of craniopharyngioma has seldom been reported.
A 30-year-old woman presented with a 5-month history of amenorrhea and was admitted to the hospital. She underwent surgical resection for three times and died at last. MRI revealed a new solid component of craniopharyngioma. Pathologic examination revealed malignant changes in the craniopharyngioma. In addition, We analyzed the expression of Ki-67, p53, VEGF, and MMP-9 in this malignant case after the third operation and in samples from 9 benign craniopharyngiomas. Immunohistochemical analysis showed that the Ki-67 index was higher in malignant craniopharyngiomas (50%) compared with benign craniopharyngiomas (3.0% ± 1.5%; range, 1.0%-6.0%). The p53, MMP-9, and VEGF protein levels were higher in the malignant craniopharyngioma compared with the benign craniopharyngiomas.
Patients with a high Ki-67 index and high p53, MMP-9, and VEGF protein levels and a new solid component of craniopharyngioma on MRI may benefit from aggressive treatment and close surveillance.
颅咽管瘤是一种罕见的颅内良性肿瘤，可通过手术或辅助放疗成功治疗。颅咽管瘤的恶变鲜有报道。
一名30岁女性因闭经5个月入院。她接受了三次手术切除，最终死亡。磁共振成像（MRI）显示颅咽管瘤有新的实性成分。病理检查显示颅咽管瘤发生了恶变。此外，我们分析了该恶性病例第三次手术后以及9例良性颅咽管瘤样本中Ki-67、p53、血管内皮生长因子（VEGF）和基质金属蛋白酶-9（MMP-9）的表达。免疫组织化学分析显示，恶性颅咽管瘤的Ki-67指数（50%）高于良性颅咽管瘤（3.0%±1.5%；范围为1.0%-6.0%）。与良性颅咽管瘤相比，恶性颅咽管瘤中p53、MMP-9和VEGF蛋白水平更高。
Ki-67指数高、p53、MMP-9和VEGF蛋白水平高且MRI显示颅咽管瘤有新实性成分的患者可能从积极治疗和密切监测中获益。
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