§5Alzheimer’sdiseaseDegenerativedisease選擇性地累及某1~2個功能系統的神經細胞。老年性癡呆臨床表現：progressivedementiaCNS功能的全面衰退，記憶和認知功能逐漸喪失，直至癡呆而死亡。7~10年以上。老年性癡呆Alzheimer’sdisease（AD)1907Al?isAlzheimer報告：51歲，女性，多疑，記憶力障礙，時間、地點、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歲以上老年性癡呆Alzheimer’sdisease

病因發病

不明，4個

AD相關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老年性癡呆

N端C端細胞外細胞膜細胞內APP非A

生成途徑P3P7

P3CTA

生成途徑A

P7

A4CT

APPsAPP水解及A

生成模式圖老年性癡呆Alzheimer’sdisease

病理變化肉眼

Brainatrophy組織學

Neurofibrillarytangles神經原纖維纏結

Senileplaques老年斑

Amyloidangiopathy淀粉樣血管病

Granulovacuolardegeneration顆粒空泡變性

Lossofneurons老年性癡呆InthiscaseofAlzheimer'sdisease,thereismoremarkedatrophyseensuperiorlyandlaterally,withsparingoftheoccipitalregion.178老年性癡呆神經原纖維纏結Thisisaneurofibrillary"tangle"ofAlzheimer'sdisease.Thetangleappearsaslongpinkfilamentsinthecytoplasm.Theyarecomposedofcytoskeletalintermediatefilaments.

098老年性癡呆Neurofibrillarychange

Agimpregnation老年性癡呆SenileplaqueTheplaquesofAlzheimer'sdiseaseareseenherewithasilverstain.Suchplaquesaremostnumerousinthecerebralcortexandhippocampus.Thisdementiaismarkedmainlybyprogressivememoryloss.091

老年性癡呆Primaryintracranialtumor:

Glioma膠質瘤（40%）

Meningioma腦膜瘤（15%）

Acousticneurinoma聽神經瘤（8%）

Metastatictumors:lung,breast

§6Tumors分類發病率children:glioma,medulloblastoma

髓母細胞瘤老年性癡呆Size,location>natureLocaleffectGeneraleffect特點影響Biologic~histologicmalignancyInvasionMetastasistumor老年性癡呆Differentiation分化ClinicalprogressionGeneticchangesI.Astrocytoma

星形細胞瘤AstrocytomaAnaplasticastrocytoma間變性-Glioblastomamultiforme多形性膠質母細胞瘤老年性癡呆atypia,mitoticrate,capillary,endothelialcells,necrosis,hemorrhageAstrocytomaAnaplasticastrocytomaGlioblastomamultiformepoorlydefinedgray-whitesolidmultiform多形性:cyst,necrosis,hemorrhageAstrocytona病變老年性癡呆P53

mutation/lossofchr.17pLossofchr.22qRb

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

SeedingthroughCSFHighlymalignantII.Medulloblastoma

髓母細胞瘤老年性癡呆Medulloblastoma老年性癡呆老年性癡呆Seedingofmedulloblastoma老年性癡呆

From:arachnoidcell蛛網膜細胞

部位:~arachnoidgranulationdura硬腦膜

大體：solid,gritty砂粒樣

光鏡：whorl-likepatternpsammoma砂粒體

Malignant:rareIII.Meningioma腦膜瘤老年性癡呆meningioma老年性癡呆Hereisanotherbenignmeningiomabeneaththedura.Theseneoplasmsareslowgrowing,butmayreachalargesizebeforesymptomsleadtodetection.老年性癡呆Meningiomaofsphenoidwing老年性癡呆老年性癡呆老年性癡呆老年性癡呆From:Schwanncell

大體:encapsulated,solitary~nerves,spinalroots

光鏡:Spindletumorcells,

排列成束狀，網狀

BenignIV.Neurilemmoma神經鞘瘤Schwannoma老年性癡呆Acousticschwannoma老年性癡呆Schwannomaofaspinalr