| Background and objective:Adamantinomatous craniopharyngioma(ACP)is a common congenital benign tumor in the Sellar region,which is classified as grade I according to the WHO classification of tumors of the central nervous system.However,because they are closely adjacent to the surrounding important neurovascular structure and demonstrate "malignant" biological behavior,e.g.,invading the hypothalamus with finger-like protrusion,making their management difficult and rendering many postoperative complications,high death and disability rate and poor overall prognosis.Moreover,even if the tumor is completely resected,there will be a high tumor recurrence rate,an important factor affecting the treatment and prognosis of ACP.At present,there are many studies on the factors affecting the recurrence of ACP from clinical aspects,such as tumor consistency,tumor size,the degree of adhesion to the surrounding tissue and so on.However,these factors cannot explain the high recurrence rate after complete resection of ACP.At present,there are few studies on the influencing factors of recurrence after total resection of ACP.In addition,compared with other benign tumors in the sellar region,ACP has unique pathological features,such as finger-like protrusion,Whorl-like cell cluster,stellate reticular structure and so on.Whether these unique pathological features of craniopharyngioma are the independent factors leading to its recurrence after total resection is still unknown.Thus,this study aims to first clarify the clinical features and pathological structure that influence the relapse of ACP after gross total resection.Then the molecular characteristics of the pathological structure were further explored by histological studies,aiming to identify the molecular mechanism that may influence the recurrence of ACP after total resection and provide direction for future research.Ultimately,it is hoped that the development of targeted drugs targeting this molecular mechanism will reduce its recurrence and improve the prognosis of ACP patients.Methods:The clinicopathologic data of 142 ACP patients meeting the inclusion criteria admitted to Neurosurgery Department of The First Affiliated Hospital of Nanchang University from March 2012 to January 2023 were retrospectively analyzed.Univariate and multivariate logistic regression analyses were performed to explore correlation between the clinical features(including sex,age,tumor size,texture,presence of calcification,and relationship with the hypothalamus)and pathological features(including finger-like protrusion,Whorl-like cell cluster,stellate reticulum,wet keratin,ghost cells,cholesterol crystals,and inflammatory cell infiltration)of the patients and recurrence after total ACP resection.Furthermore,HE staining and immunofluorescence staining were used to histologically study the pathological features affecting the recurrence of ACP after total resection.Results:1.Univariate and multivariate logistic regression analysis showed that ACP invasion of hypothalamus and pathological finger-like protrusion and Whorl-like cell clusters were associated with recurrence after total resection(P < 0.05).There was no correlation between tumor size,tumor consistency,calcification,peripheral pallisading epithelium,stellate reticulum,wet keratin,ghost cells,cholesterol crystals,inflammatory cell infiltration and recurrence after total ACP resection(P > 0.05).2.Recurrence after total ACP resection often occurs at the site of tumor origin,and the pathological features of this site are mainly finger-like protrusion,which is characterized by β-catenin nucleus accumulation and CD133 and CD44 positive cells.There was no finger-like protrusion at the non-origin site,and cells with nuclear accumulation of β-catenin and positive CD133 or CD44 were missing.Conclusion:Invasion of hypothalamus,finger-like protrusion and Whorl-like cell cluster are important factors affecting the postoperative recurrence of APC after gross total resection. |
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