CRAN-32. CASE BASED LEARNING: THREE CENTURIES OF LESSONS FROM TWO CRANIOPHARYNGEOMA PATIENTS
CRAN-32. CASE BASED LEARNING: THREE CENTURIES OF LESSONS FROM TWO CRANIOPHARYNGEOMA PATIENTS
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CRAN-32。
DOI：
10.1093/neuonc/noy059.068
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发表时间：
2018
期刊：
影响因子：
15.9
通讯作者：
Apps J
中科院分区：
文献类型：
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作者：
Apps J
基于病例的学习是世界各地医学本科课程的核心组成部分；数千年来，它被用来传授人类生理学、症状学、病理学和临床治疗方面的知识。我们提出了两例颅咽管瘤(CP)，在1839年至2017年的不同时间点分别进行的研究影响了我们对垂体和下丘脑的正常功能以及其病理分类的理解。基于储存在奥地利维也纳病理解剖博物馆的两个CP标本，我们回顾了约瑟夫·恩格尔在现代病理学之父之一卡尔·冯·罗基坦斯基的主持下于1839年开始对这些病例进行的临床病理分析，雅各布·埃尔德海姆在他1904年的论文中重新分析了这些“垂体管肿瘤”作为其自身的病理实体。自从H.库欣(不恰当地)将它们重新命名为颅咽管瘤以来，尽管最近在了解它们的分子生物学方面取得了进展，但它们仍然是“最可怕的颅内肿瘤”之一。最后，在2017年，这两个样本在伦敦(英国)通过先进的成像(3T磁共振和高分辨率显微CT)进行了重新分析，以补充组织学研究。单独研究的结论突出了数据的解释如何受到当时的技术/方法和主流理论的影响。
Case-based learning is a core component of medical undergraduate curricula across the world; it has been used to impart knowledge of human physiology, symptomatology, pathology, and clinical therapy for millenia. We present two cases of craniopharyngeoma (CP) where separate studies at different time points between 1839 and 2017 have impacted on our understanding of the normal function of the pituitary and the hypothalamus as well as the classification of its pathology. Based on 2 specimens of CP stored in the Pathological-Anatomical Museum in Vienna, Austria, we retraced the clinical-pathological analyses of these cases starting in 1839 by Josef Engel under the auspices of Karl von Rokitansky, one of the fathers of modern pathology, reanalysed in detail by Jakob Erdheim in his 1904 paper recognizing these „hypophyseal duct tumors“ as a pathologic entity of its own. Ever since H.Cushing (improperly) renamed them craniopharyngeomas they remain one of the „most formidable intracranial tumors“ despite recent advances in understanding their molecular biology. Lastly in 2017 the two samples were reanalysed in London (UK) by advanced imaging (3T MR and high-resolution micro-CT) supplementing histological studies. The conclusions of the separate studies highlight how the interpretation of data is shaped by the technologies/methodologies and prevailing theories of the time.