Division of Neuropathology, Department of Pathology, University of California San Francisco, San Francisco, CA, United States.
Division of Neuropathology, Department of Pathology, University of California San Francisco, San Francisco, CA, United States.
Handb Clin Neurol. 2020;169:87-99. doi: 10.1016/B978-0-12-804280-9.00005-6.
Meningiomas are a diverse group of neoplasms that exhibit a wide range of morphologies and clinical behavior. They are generally accepted to originate from arachnoid cap cells within the leptomeninges. Classic histologic features include whorl formations, psammoma bodies, nuclear holes, and nuclear pseudoinclusions. Meningiomas are classified as benign, atypical, or anaplastic (grades I, II, or III) based on histologic features including mitotic activity, brain invasion, and presence of other minor criteria. There are numerous histologic variants of meningiomas, and some are associated with worse clinical outcomes and therefore are assigned a higher grade. The majority of meningiomas show diffuse positivity for vimentin and epithelial membrane antigen, supporting the dual mesenchymal and epithelial nature of meningothelial cells. The presence of an elevated proliferation index (as measured by Ki-67 immunohistochemical stain) and loss of progesterone receptor expression are associated with the higher grade. Pathologic features including histologic variants, grading criteria, and ancillary tests such as special and immunohistochemical stains are discussed.
脑膜瘤是一组表现出多种形态和临床行为的肿瘤。它们通常被认为起源于软脑膜中的蛛网膜帽细胞。经典的组织学特征包括漩涡形成、砂粒体、核孔和核假包涵体。脑膜瘤根据组织学特征，如有丝分裂活性、脑侵犯和存在其他次要标准，分为良性、非典型或间变性（I、II 或 III 级）。脑膜瘤有许多组织学变异型，其中一些与更差的临床结局相关，因此被分配更高的级别。大多数脑膜瘤弥漫性表达波形蛋白和上皮膜抗原，支持脑膜内皮细胞的双重间充质和上皮性质。增殖指数升高（通过 Ki-67 免疫组化染色测量）和孕激素受体表达缺失与高级别相关。讨论了组织学变异型、分级标准以及辅助检查，如特殊和免疫组织化学染色等病理特征。
