Association between Intracranial Plasmacytoma and Multiple Myeloma: Clinicopathological Outcome Study
Association between Intracranial Plasmacytoma and Multiple Myeloma: Clinicopathological Outcome Study
复制标题
颅内浆细胞瘤与多发性骨髓瘤之间的关联：临床病理结果研究
作者：
T. Schwartz;Richard Rhiew;S. Isaacson;A. Orazi;J. Bruce
目的 颅内浆细胞瘤是罕见的病变，可起源于颅骨、硬脑膜或颅底，除非与骨髓瘤相关，否则呈良性病程。最近人们的注意力集中在细胞粘附分子 CD56 和 CD31 在骨髓瘤发病机制中的作用。对于颅内浆细胞瘤和骨髓瘤相关病变，尚无此类信息。方法我们研究了一系列九个颅内浆细胞瘤（三个硬脑膜、一个颅骨和五个颅底病变）的 CD56 和 CD31 表达、颅内位置和骨髓瘤进展之间的关系。这些参数还与通过组织学切片的 MIB-1 免疫染色评估的增殖指数相关。一名病理学家 (AO) 进行了免疫组织化学分析并审查了所有载玻片。结果颅内浆细胞瘤在女性患者中更常见（89%）。三个硬脑膜病变为 CD56 和 CD31 阴性，MIB-1 染色低于 10%；没有患者出现骨髓瘤或复发。 5个颅底病变中，3个CD56阳性，无CD31阳性，2个MIB-1标记超过45%，具有浆母细胞形态学特征。与其他颅内浆细胞瘤相比，5 名颅底病变患者中有 5 名在 8 个月内发展为骨髓活检证实的骨髓瘤（P < 0.05）。颅骨病变为 CD56 和 CD31 阳性，患者诊断后不久就出现骨髓瘤。两种高度增殖性浆母细胞病变均复发，一种是在未进行放疗的大体全切除后复发，另一种是在活检和 2000 cGy 放疗后复发。结论 在颅内浆细胞瘤中，颅底位置是多发性骨髓瘤发展的最强预测因子。细胞粘附分子 CD31 和 CD56 的表达不能预测结果。髓外硬脑膜病变 CD56 阴性，与骨髓瘤无关。高增殖指数和浆母细胞形态特征预示着短时间内的复发和攻击行为。我们建议对所有颅内浆细胞肿瘤进行 4050 至 5040 cGy 分割放疗，并对非颅底病变进行大体全切除。
OBJECTIVEIntracranial plasmacytomas are rare lesions that can arise from the calvarium, dura, or cranial base and exhibit a benign course unless associated with myeloma. Attention has recently been focused on the role of the cell adhesion molecules CD56 and CD31 in the pathogenesis of myeloma. No such information is available for intracranial plasmacytomas and myeloma-associated lesions. METHODSWe investigated the relationship between CD56 and CD31 expression, intracranial location, and progression to myeloma for a series of nine intracranial plasmacytomas (three dural, one calvarial, and five cranial base lesions). These parameters were also correlated with proliferation indices, as assessed by MIB-1 immunostaining of the histological sections. A single pathologist (AO) performed immunohistochemical analyses and reviewed all slides. RESULTSIntracranial plasmacytomas presented more commonly in female patients (89%). The three dural lesions were CD56- and CD31-negative and exhibited MIB-1 staining of less than 10%; no patient developed myeloma or recurrence. Of the five cranial base lesions, three were CD56-positive, none was CD31-positive, and two exhibited MIB-1 labeling of more than 45%, with plasmablastic morphological features. Compared with other intracranial plasmacytomas, five of five patients with cranial base lesions developed bone marrow biopsy-proven myeloma (P < 0.05) within 8 months. The calvarial lesion was CD56- and CD31-positive, and the patient developed myeloma soon after diagnosis. Both of the two highly proliferative plasmablastic lesions recurred, one after gross total resection without radiotherapy and the other after a biopsy and 2000-cGy radiotherapy. CONCLUSIONAmong intracranial plasmacytomas, cranial base location was the strongest predictor of the development of multiple myeloma. Expression of the cell adhesion molecules CD31 and CD56 was not predictive of outcome. Extramedullary dural-based lesions were CD56-negative and were not associated with myeloma. A high proliferation index and plasmablastic morphological features were predictive of a short time to recurrence and aggressive behavior. We recommend 4050- to 5040-cGy fractionated radiotherapy for all intracranial plasma cell neoplasms and gross total resection for non-cranial base lesions.
影响因子：
15.9
作者：
Yanase, K;Smith, RM;Madaio, MP
通讯作者：
Madaio, MP
影响因子：
15.9
作者：
Newman, PJ
通讯作者：
Newman, PJ