老年性癡呆醫(yī)學(xué)知識培訓(xùn)

§5Alzheimer’sdiseaseDegenerativedisease選擇性地累及某1~2個功能系統(tǒng)旳神經(jīng)細(xì)胞。老年性癡呆臨床體現(xiàn)：progressivedementiaCNS功能旳全面衰退，記憶和認(rèn)知功能逐漸喪失，直至癡呆而死亡。7~2023年以上。第1頁Alzheimer’sdisease（AD)1907Al?isAlzheimer報告：51歲，女性，多疑，記憶力障礙，時間、地點(diǎn)、定向力障礙，4年半后死亡。目前西方：5%65歲以上，上海：3%65歲以上，4.69%70歲以上第2頁Alzheimer’sdisease

病因發(fā)病不明，4個AD有關(guān)基因編碼蛋白基因定位APPgeneamyloid-proteinprecursor21q11.2-21q22.1ApoE載脂蛋白E19q13-13.2PS1早老蛋白1(Presinilin1)14q24.3PS2早老蛋白21q31-42第3頁N端C端細(xì)胞外細(xì)胞膜細(xì)胞內(nèi)APP非A生成途徑P3P7

P3CTA生成途徑AP7

A4CTAPPsAPP水解及A生成模式圖第4頁Alzheimer’sdisease

病理變化肉眼Brainatrophy組織學(xué)

Neurofibrillarytangles神經(jīng)原纖維纏結(jié)Senileplaques老年斑Amyloidangiopathy淀粉樣血管病Granulovacuolardegeneration顆?？张葑冃?/p>

Lossofneurons第5頁InthiscaseofAlzheimer'sdisease,thereismoremarkedatrophyseensuperiorlyandlaterally,withsparingoftheoccipitalregion.178第6頁神經(jīng)原纖維纏結(jié)Thisisaneurofibrillary"tangle"ofAlzheimer'sdisease.Thetangleappearsaslongpinkfilamentsinthecytoplasm.Theyarecomposedofcytoskeletalintermediatefilaments.

098第7頁Neurofibrillarychange

Agimpregnation第8頁SenileplaqueTheplaquesofAlzheimer'sdiseaseareseenherewithasilverstain.Suchplaquesaremostnumerousinthecerebralcortexandhippocampus.Thisdementiaismarkedmainlybyprogressivememoryloss.091

第9頁P(yáng)rimaryintracranialtumor:

Glioma膠質(zhì)瘤（40%）Meningioma腦膜瘤（15%）Acousticneurinoma聽神經(jīng)瘤（8%）Metastatictumors:lung,breast

§6Tumors分類發(fā)病率children:glioma,medulloblastoma

髓母細(xì)胞瘤第10頁Size,location>natureLocaleffectGeneraleffect特點(diǎn)影響B(tài)iologic~histologicmalignancyInvasionMetastasistumor第11頁Differentiation分化ClinicalprogressionGeneticchangesI.Astrocytoma星形細(xì)胞瘤AstrocytomaAnaplasticastrocytoma間變性-Glioblastomamultiforme多形性膠質(zhì)母細(xì)胞瘤第12頁atypia,mitoticrate,capillary,endothelialcells,necrosis,hemorrhageAstrocytomaAnaplasticastrocytomaGlioblastomamultiformepoorlydefinedgray-whitesolidmultiform多形性:cyst,necrosis,hemorrhageAstrocytona病變第13頁P(yáng)53

mutation/lossofchr.17pLossofchr.22qRb

mutation/lossofchr.13qP16deletion/lossofchr.3pLossofchr.19qLossofch.10EGFRgeneamplificationGeneticchangesinastrocytomaNormalastrocyteAstrocytomaAnaplasticastrocytomaGlioblaxtomamultiforme第14頁astrocytoma第15頁第16頁Astrocytoma第17頁Glioblatonamultiforme第18頁Giantcellsinglioblastomamultiforme第19頁Giantcellsinglioblastomamultiforme第20頁Giantcellsinglioblastomamultiforme,IHGFAP第21頁P(yáng)seudopalisading(glioblastomamultiforme)第22頁Endothelialcellproliferationglioblastomamultiforme第23頁<20yCerebellumPrimitiveundifferentiatedcellsmalltumorcells,scantycytoplasmrosette菊形團(tuán)SeedingthroughCSFHighlymalignantII.Medulloblastoma

髓母細(xì)胞瘤第24頁Medulloblastoma第25頁第26頁Seedingofmedulloblastoma第27頁

From:arachnoidcell蛛網(wǎng)膜細(xì)胞

部位:~arachnoidgranulationdura硬腦膜

大體：solid,gritty砂粒樣

光鏡：whorl-likepatternpsammoma砂粒體Malignant:rareIII.Meningioma腦膜瘤第28頁meningioma第29頁Hereisanotherbenignmeningiomabeneaththedura.Theseneoplasmsareslowgrowing,butmayreachalargesizebeforesymptomsleadtodetection.第30頁Meningiomaofsphenoidwing第31頁第32頁第33頁第34頁From:Schwanncell大體:encapsulated,solitary~nerves,spinalroots光鏡:Spindletumorcells,

排列成束狀，網(wǎng)狀BenignIV.Neurilemmoma神經(jīng)鞘瘤Schwannoma第35頁Acousticschwannoma第36頁Schwannom