复发性脑膜瘤的病理形态特征

V. V. Ushanov, K. K. Kukanov, A. A. Paltsev, A. S. Tsyndyaykina, N. A. Zayachkovsky, M. V. Pryanikov, Yu. M. Zabrodskaya
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摘要

背景。脑膜瘤是中枢神经系统的常见肿瘤,大多数是良性的。无弹性脑膜瘤和非典型脑膜瘤占所有脑膜瘤的 25%,即使经过全切和放疗,其复发率也很高,这决定了其预后明显较差。人们对其复发机制仍知之甚少。评估蛛网膜肉芽在脑膜瘤复发中的重要性;介绍我们自己的临床病例;回顾有关这一主题的文献。我们在 Pubmed、EMBASE、Cohrane Library 和 eLibrary 数据库中检索了自数据库管理开始至 2023 年 2 月期间发表的有关蛛网膜肉芽在脑膜瘤复发中的作用的文献。本研究采用了在阿尔马佐夫国立医学研究中心接受治疗的71岁颅内脑膜瘤患者的病史材料和组织学检查结果。结果描述了颅内脑膜瘤手术的临床病例。肿瘤的组织学检查显示为乳头状脑膜瘤,3 级。脑膜瘤的肿瘤生长在蛛网膜的肉芽中。综述显示,该临床病例表明,蛛网膜肉芽在确定这类患者的临床治疗方案方面非常重要。本临床病例和文献资料分析表明,考虑蛛网膜肉芽结构对颅内脑膜瘤患者,尤其是复发性脑膜瘤患者非常重要。蛛网膜肉芽的作用目前已被 "遗忘",但对这些重要结构在肿瘤范围内的研究可为脑膜瘤的肿瘤发生、恶变和复发提供新的信息和机制,可作为将其纳入对这类患者进行最终病理形态学诊断的标准的依据。
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Рathomorphological features of recurrent meningiomas
Background. Meningiomas are common tumors of the central nervous system, most of which are benign. Anaplastic and atypical meningiomas, which together account for 25 % of all meningiomas, have a high recurrence rate even after gross total resection and radiotherapy, which determines a significantly worse prognosis. The mechanisms of recurrence remain poorly understood.Purpose. To assess the significance of arachnoid granulations in the recurrence of meningiomas; to present our own clinical case; to make the review of the literature on this topic.Materials and methods. We searched for publications in the Pubmed, EMBASE, Cohrane Library, and eLibrary databases published between the beginning of database management to February 2023 on the issue of the role of arachnoid granulation in meningioma reccurence. The materials of the desease history and results of histological examination of 71-year-old with intracranial meningioma who were treated in Almazov National Medical Research Center are used in this work.Results. The clinical case of intracranial meningioma surgery is described. Histological examination of the tumor revealed papillary meningioma, grade 3. Tumor growth of meningioma was found in the granulations of the arachnoid. According to the review the clinical case shows the importance of the arachnoid granulations in determining the clinical management for this group of patients.Conclusion. The presented clinical case and analysis of literature data demonstrates the importance of considering the structure of arachnoid granulations in patients with intracranial meningiomas, especially in the recurrent type of the disease. The role of granulations of the arachnoid membrane is currently “forgotten”, but the study of these important structures within the boundaries of the tumor field can provide new information and mechanisms of oncogenesis, malignancy, and recurrence of meningiomas, which may serve as the basis for inclusion in the standards for making a final pathomorphological diagnosis in this groups of patients.
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