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背景与目的:中枢性神经瘤是少见的中枢神经系统肿瘤。为了提高对该病的认识、减少误诊率,我们结合文献复习,对患者的临床症状、影像学、病理改变及预后进行了研究讨论。方法:复习中国人民解放军总医院1970-2000年收治的中枢性神经瘤病例共17例,对患者的临床症状、影像学、病理改变及预后进行了回顾性研究。结果:中枢性神经细胞瘤发病率占同期原发性中枢神经系统肿瘤的0.14%。患者男10例,女7例,年龄从11岁-51岁不等,平均年龄32.7岁。肿瘤均位于脑室系统,7例位于透明隔位于侧脑室及三脑室者各5例。手术全部切除7例,部分切除10例,术后放疗者9例。9例进行了长期随访无复发迹象。另外,17例行免疫组化及2例行电镜检查,显示肿瘤呈神经元分化,仅4例局部表达GFAP;所有病例均无恶性组织学迹象,4例已做Ki-67免疫组化的阳性细胞<2%。结论:综合上述及结合文献我们认为大多数中枢性神经细胞瘤是预后良好的肿瘤,部分预后较差,增加GFAP的阳性表达、细胞增殖指数的增加以及血管的增生可能提示较差的预后。手术切除为治疗该肿瘤的较好方法。对部分切除的病例、组织学呈间变改变的病例(细胞的异形性、核分裂像增加、血管内皮细胞增生及坏死)以及增殖指数增加者应辅以放疗。
Background and Objective: Central neuroma is a rare central nervous system tumor. In order to improve the understanding of the disease and reduce the rate of misdiagnosis, we reviewed the clinical symptoms, imaging, pathological changes and prognosis of patients with literature review. Methods: A total of 17 cases of central neuroma admitted to Chinese PLA General Hospital from 1970 to 2000 were retrospectively reviewed. The clinical symptoms, imaging, pathological changes and prognosis of the patients were retrospectively studied. Results: The incidence of central neurocytoma accounted for 0.14% of primary central nervous system tumors in the same period. 10 patients were male and 7 females, ranging in age from 11 years old to 51 years old, with an average age of 32.7 years. Tumors were located in the ventricular system, 7 cases were located in the transparent compartment in the lateral ventricle and three ventricle were 5 cases. Surgical resection in 7 cases, partial resection in 10 cases, postoperative radiotherapy in 9 cases. Nine patients had no signs of recurrence after long-term follow-up. In addition, 17 cases of immunohistochemistry and 2 cases of electron microscopy showed neuronal differentiation of tumors, only 4 cases of local expression of GFAP; all cases were no signs of malignant histology, 4 cases have done Ki-67 immunohistochemical positive Cells <2%. Conclusion: Based on the above and combined literature, we think that most of the central neurocytomas are well-prognosed tumors with poor prognosis and poor prognosis. Increased GFAP positive expression, increased cell proliferation index and vascular hyperplasia may indicate poor prognosis. Surgical resection is a better way to treat the tumor. Cases of partial resection, histological changes between changes in the case (abnormal cells, increased mitosis, vascular endothelial cell proliferation and necrosis) and increased proliferation index should be supplemented with radiotherapy.