Clinical imaging and pathological analysis of isolated fibrous tumors of central nervous system
中枢神经系统孤立性纤维性肿瘤临床影像学与病理学分析

摘要

目的 针对中枢神经系统孤立性纤维性肿瘤进行临床影像学、病理学分析，从中为诊断治疗提供帮助与支持。方法 从院内经过病理诊断所确诊的54例中枢神经系统孤立性纤维性肿瘤疾病患者中开展研究工作，从中对患者影像学、组织形态学以及免疫组织化学特点进行分析与总结。结果 通过研究分析得知，这些患者中含有25例男性、29例女性，年龄区间在16岁至67岁之间，其中肿瘤所在部位于颅内区域的含有45例，在椎管区域中的含有9例，绝大多数患者的肿瘤边界相对比较清晰，在磁共振信号表现中，其中T1WI多以低信号为主，占比在（47/54）左右，而T2WI普遍为较高信号、高信号混杂的不均匀信号，在病灶周围脑组织区域中可以看到存在明显的片状稍长T1稍长T2水肿区，T1WI增强扫描以均匀强化较为明显。在颅内肿瘤患者群体中，具有瘤周脑组织水肿的患者数量为18例，侵犯静脉窦的患者数量有11例，骨质破坏的患者数量为10例，脑膜尾征患者数量有6例。在组织病理诊断结果中得知，1级患者数量有27例，2级患者数量为14例，3级患者数量为13例。在免疫组织化学检查结果中可以明显看到，其中STAT6、Bcl-2、CD99以及Vimentin普遍为阳性表达，其中CD32、Ki-67指数水平较高，其余指标水平较低，GFAP、SOX10以及CK均以阴性表达为主。在随后长达1年至6年的随访期间中得知，绝大多数患者病情控制状况相对比较良好，仅有7例未全切的患者存在局部进展、远处转移等情况。结论 对于中枢神经系统孤立性纤维性肿瘤疾病而言，其中的脑膜尾征相对比较少见，而瘤周水肿率处于较高的水平，静脉窦以及颅骨侵袭率水平相对比较高，属于其中的典型影像学特征，最后在STAT6、Bcl-2、CD99、CD34以及Vimentin等指标结果中，其中的阳性表达率水平十分高，属于典型病理学特征，所以从这些特征结果中得知，将影像学检测结果和免疫组化进行有机结合，对提高诊断效率与质量具有重要作用。

Abstract

Objective To conduct clinical imaging and pathological analysis of isolated fibrous tumors of the central nervous system in order to provide help and support for diagnosis and treatment.
Methods 54 patients with isolated fibrous neoplasms of central nervous system diagnosed by pathological diagnosis were studied. The imaging, histomorphology and immunohistochemical characteristics of the patients were analyzed and summarized.
Results According to the study analysis, among these patients, 25 were male and 29 were female, ranging in age from 16 to 67 years old. Among them, 45 patients had tumors located in the intracranial region, and 9 patients had tumors in the spinal canal region. The tumor boundaries of most patients were relatively clear. In MRI signal manifestations, T1WI was dominated by low signal, accounting for about (47/54), while T2WI was generally characterized by uneven signals with high signal and mixed signals. Obvious flaky and slightly longer T1 and slightly longer T2 edema areas could be seen in the brain tissue area around the lesion. T1WI enhanced scan showed more obvious uniform enhancement. Among the patients with intracranial tumors, the number of patients with peritumoral brain tissue edema was 18, the number of patients with venous sinus invasion was 11, the number of patients with bone destruction was 10, and the number of patients with meningeal tail sign was 6. According to the histopathological diagnosis results, there were 27 patients with grade 1, 14 patients with grade 2 and 13 patients with grade 3. The results of immunohistochemical examination showed that STAT6, Bcl-2, CD99 and Vimentin were generally positive, among which CD32 and Ki-67 index levels were high, while other indexes were low. GFAP, SOX10 and CK were mainly negative. During the follow-up period of 1 to 6 years, it was found that the disease control status of the vast majority of patients was relatively good, and only 7 patients with incomplete resection had local progression and distant metastasis.
Conclusion   For isolated fibrous neoplasms of the central nervous system, the meningeal tail sign is relatively rare, while the rate of peritumoral edema is relatively high, and the invasion rate of venous sinus and skull is relatively high, which belong to the typical imaging features. Finally, in the results of STAT6, Bcl-2, CD99, CD34, Vimentin and other indicators, the positive expression rate is very high, which belongs to typical pathological characteristics. Therefore, it can be seen from these characteristic results that the organic combination of imaging detection results and immunohistochemistry plays an important role in improving the diagnostic efficiency and quality.