老年性痴呆课件

§5Alzheimer’sdiseaseDegenerativedisease选择性地累及某1~2个功能系统的神经细胞。老年性痴呆临床表现：progressivedementiaCNS功能的全面衰退，记忆和认知功能逐渐丧失，直至痴呆而死亡。7~10年以上。老年性痴呆Alzheimer’sdisease（AD)1907AlÖisAlzheimer报告：51岁，女性，多疑，记忆力障碍，时间、地点、定向力障碍，4年半后死亡。目前西方：5%65岁以上，上海：3%65岁以上，4.69%70岁以上老年性痴呆Alzheimer’sdisease

病因发病

不明，4个

AD相关基因编码蛋白基因定位APPgeneamyloid

-proteinprecursor21q11.2-21q22.1ApoE载脂蛋白E19q13-13.2PS1早老蛋白1(Presinilin1)14q24.3PS2早老蛋白21q31-42老年性痴呆

N端C端细胞外细胞膜细胞内APP非A

生成途径P3P7

P3CTA

生成途径A

P7

A4CT

APPsAPP水解及A

生成模式图老年性痴呆Alzheimer’sdisease

病理变化肉眼

Brainatrophy组织学

Neurofibrillarytangles神经原纤维缠结

Senileplaques老年斑

Amyloidangiopathy淀粉样血管病

Granulovacuolardegeneration颗粒空泡变性

Lossofneurons老年性痴呆InthiscaseofAlzheimer'sdisease,thereismoremarkedatrophyseensuperiorlyandlaterally,withsparingoftheoccipitalregion.178老年性痴呆神经原纤维缠结Thisisaneurofibrillary"tangle"ofAlzheimer'sdisease.Thetangleappearsaslongpinkfilamentsinthecytoplasm.Theyarecomposedofcytoskeletalintermediatefilaments.

098老年性痴呆Neurofibrillarychange

Agimpregnation老年性痴呆SenileplaqueTheplaquesofAlzheimer'sdiseaseareseenherewithasilverstain.Suchplaquesaremostnumerousinthecerebralcortexandhippocampus.Thisdementiaismarkedmainlybyprogressivememoryloss.091

老年性痴呆Primaryintracranialtumor:

Glioma胶质瘤（40%）

Meningioma脑膜瘤（15%）

Acousticneurinoma听神经瘤（8%）

Metastatictumors:lung,breast

§6Tumors分类发病率children:glioma,medulloblastoma

髓母细胞瘤老年性痴呆Size,location>natureLocaleffectGeneraleffect特点影响Biologic~histologicmalignancyInvasionMetastasistumor老年性痴呆Differentiation分化ClinicalprogressionGeneticchangesI.Astrocytoma

星形细胞瘤AstrocytomaAnaplasticastrocytoma间变性-Glioblastomamultiforme多形性胶质母细胞瘤老年性痴呆atypia,mitoticrate,capillary,endothelialcells,necrosis,hemorrhageAstrocytomaAnaplasticastrocytomaGlioblastomamultiformepoorlydefinedgray-whitesolidmultiform多形性:cyst,necrosis,hemorrhageAstrocytona病变老年性痴呆P53

mutation/lossofchr.17pLossofchr.22qRb

mutation/lossofchr.13qP16deletion/lossofchr.3pLossofchr.19qLossofch.10EGFRgeneamplificationGeneticchangesinastrocytomaNormalastrocyteAstrocytomaAnaplasticastrocytomaGlioblaxtomamultiforme老年性痴呆astrocytoma老年性痴呆老年性痴呆Astrocytoma老年性痴呆Glioblatonamultiforme老年性痴呆Giantcellsinglioblastomamultiforme老年性痴呆Giantcellsinglioblastomamultiforme老年性痴呆Giantcellsinglioblastomamultiforme,IHGFAP老年性痴呆Pseudopalisading(glioblastomamultiforme)老年性痴呆Endothelialcellproliferationglioblastomamultiforme老年性痴呆<20yCerebellumPrimitiveundifferentiatedcellsmalltumorcells,scantycytoplasmrosette菊形团

SeedingthroughCSFHighlymalignantII.Medulloblastoma

髓母细胞瘤老年性痴呆Medulloblastoma老年性痴呆老年性痴呆Seedingofmedulloblastoma老年性痴呆

From:arachnoidcell蛛网膜细胞

部位:~arachnoidgranulationdura硬脑膜

大体：solid,gritty砂粒样

光镜：whorl-likepatternpsammoma砂粒体

Malignant:rareIII.Meningioma脑膜瘤老年性痴呆meningioma老年性痴呆Hereisanotherbenignmeningiomabeneaththedura.Theseneoplasmsareslowgrowing,butmayreachalargesizebeforesymptomsleadtodetection.老年性痴呆Meningiomaofsphenoidwing老年性痴呆老年性痴呆老年性痴呆老年性痴呆From:Schwanncell

大体:encapsulated,solitary~nerves,spinalroots

光镜:Spindletumorcells,

排列成束状，网状

BenignIV.Neurilemmoma神经鞘瘤Schwannoma老年性痴呆Acousticschwannoma老年性痴呆Schwannomaofaspinalr