Biochemical and clinical studies of melatonin secretion of the brain tumors in pineal region.

本文用高效液相色谱法对27例脑积水患者脑脊液中褪黑激素(MLT)的昼间变化进行了研究。其中先天性脑积水3例(脊柱裂1例，Chiari II型畸形2例)，脑膜后积水4例，脑肿瘤15例(交叉生殖细胞瘤3例，额叶恶性胶质瘤3例，颞叶恶性胶质瘤1例；生殖细胞瘤1例，畸胎瘤2例，卵黄囊瘤1例，松果体区表皮细胞瘤2例，卵黄囊瘤1例)，正常压力脑积水5例。于0930~1030h通过分流系统或侧脑室冲洗装置采集脑脊液。在松果体区无脑膜炎或肿瘤的患者中，10岁以下的患者的褪黑素水平高于20岁以上的患者。即使在15岁以上的患者中，…患者的脑脊液MLT值也更高更多的S患有脑膜炎或松果体区肿瘤。这些结果提示松果体肿瘤的炎症或侵袭可能刺激松果体分泌MLT。然而，在所有40岁以上的患者中，MLT值都较低。因此，如果可以利用脑脊液中MLT值的变化作为肿瘤标志物或用于确定治疗方式，则应适当考虑脑脊液采集时间、脑膜炎年龄。此外，在决定治疗模式时，是否存在昼夜节律变化是非常重要的。松果体细胞瘤(PCTS)患者脑脊液(CSF)或血清中的褪黑素水平并不总是表明PCT的存在，有时松果体内及周围胶质瘤或GCTS刺激松果体时，褪黑素水平会升高。另一方面，在苏木精-伊红(HE)染色的组织中，GCTS和PCTS的组织学诊断有时非常困难。GCTS的肿瘤标志物很多，但PCTS的肿瘤标志物尚不清楚。我们用间接免疫细胞化学技术研究了褪黑素是否是PCTS的特异性肿瘤标志物。PCT标本松果体母细胞瘤细胞染色阳性，阳性率高于松果体细胞瘤细胞。然而，在松果体母细胞瘤的老年组织中，阳性率较低。所有GCTS和对照标本均未见阳性染色。结论：褪黑素是PCTS的一种有用的肿瘤标志物，免疫组织化学染色是鉴别PCTS与其他肿瘤的可靠方法。较少

The changes in daytime levels of melatonin (MLT) in the cerebrospinal fluid (CSF) of twenty seven hydrocephalic patients were studied by the high-performance liquid chromatiography (HPLC) method. Patients comprised three with congenital hydrocephalus (spina bifida 1, Chiari type II malformation 2), four postmeningitic hydrocephalus, fifteen brain tumors (chiasmal germinoma 3 ; malignant glioma of frontal 3, and temporal lobes 1 ; germinoma 1, teratoma 2, yolk sac tumor 1, epidergerminoma 1, teratoma 2, yolk sac tumor 1, epidermoid 1 in pineal region) and five cases of normal pressure hydrocephalus. CSF was collected between 0930 and 1030h through puncture of the flushing device of shunt systm or the lateral ventricle. The lowest value of MLT detected by HPLC was 15 pg/ml.Melatonin values were higher in patients aged under 10 years than over 20 years in the absence of meningitis or tumor in the pineal region. Even at ages over 15 years, higher CSF MLT values were obtained in the patient … More s with meningitis or tumors in the pineal region. These results suggest that the inflammation or invasion of tumor into the pineal gland may stimulate the secretion of MLT by the pineal gland. However, lower MLT values were obtained in all patients over 40 years old. For these reasons, if one may use the changes of MLT values in CSF as a tumor maker or for determination of the treatment modality, time of CSF collection, age of meningitis should be given due consideration.Also, the presence or absence of the rhythmical changes of melatonin values in a day following circadian rhythm are very important in determination of the treatment modality.Melatonin values in cerebrospinal fluid (CSF) or serum of the pineal cell tumor (PCTS) patients do not always indicate the presence of PCT, and sometimes they go up in presence of the pineal stimulation by the gliomas or GCTs in and around the pineal gland. On the other hand, the histological diagnosis of GCTs and PCTs is sometimes very difficult on hematoxylin and eosin (HE) stained tissue. There are many tumors markers for GCTS, however, the tumor marker of PCTs has not yet been clarified. We studied whether melatonin is a specific tumor marker of PCTs or not using indirect immunocytochemical technique. PCT specimens stained positive with pineoblastoma cell showing higher positivity than pineocytoma cell. However, lower positivity was seen in older tissues of pineoblastoma. No positive stain was seen in all of the GCTs and control specimens. In the specimens of normal pineal glands, the positivity ratio was higher in adult than in the infant.In summary, melatonin is a useful tumor marker of PCTs and immunohistochemical staining for melatonin is a reliable examination for differential diagnosis of PCTs and other tumors. Less