Jones H, Steart P V, Weller R O
Department of Neuropathology, Southampton University Medical School, Southampton General Hospital.
Neuropathol Appl Neurobiol. 1991 Jun;17(3):177-87. doi: 10.1111/j.1365-2990.1991.tb00713.x.
'Gliosarcomas' have long been considered to be mixed gliomas and sarcomas. The present study failed to define criteria which clearly delineate 'gliosarcomas' from glioblastoma multiforme and suggests that 'gliosarcomas' should be considered as spindle cell glioblastomas. A total of six cases originally diagnosed as 'gliosarcomas' were compared with four cases of glioblastoma multiforme. No clinical or prognostic features were defined which would clearly separate 'gliosarcomas' from glioblastoma multiforme. Macroscopically, biopsies from 'gliosarcomas' ranged from firm, apparently well-circumscribed tumours to poorly circumscribed lesions with a soft consistency resembling glioblastoma multiforme. Histology revealed a continuous spectrum in which 'gliosarcomas' with large reticulin-rich areas of spindle cells merged with typical glioblastomas containing only small islands of spindle cells and reticulin staining. Immunocytochemistry for glial fibrillary acidic protein (GFAP); S100 protein and alpha-smooth muscle actin (ASMA) showed that the majority of cells in reticulin-poor areas of 'gliosarcoma' and glioblastomas expressed S100 protein and GFAP; many expressed ASMA and some expressed both GFAP and ASMA. Spindle cells in reticulin-rich areas of 'gliosarcomas' and glioblastomas most frequently expressed ASMA but many cells also expressed S100 protein and GFAP; some cells expressed both GFAP and ASMA. The results of this study and a review of the literature suggests that there is a clinical, radiological and pathological continuum with glioblastoma and 'gliosarcoma' at different ends of the spectrum. It is suggested, therefore, that most, if not all, 'gliosarcomas' be redesignated as spindle cell glioblastomas and not be considered as a mixture of glioma and sarcoma.
长期以来，“胶质肉瘤”一直被认为是混合性胶质瘤和肉瘤。本研究未能确定能将“胶质肉瘤”与多形性胶质母细胞瘤明确区分开来的标准，并表明“胶质肉瘤”应被视为梭形细胞胶质母细胞瘤。将最初诊断为“胶质肉瘤”的6例病例与4例多形性胶质母细胞瘤进行了比较。未发现能将“胶质肉瘤”与多形性胶质母细胞瘤明确区分的临床或预后特征。宏观上，“胶质肉瘤”的活检标本范围从质地坚硬、边界明显的肿瘤到边界不清、质地柔软类似多形性胶质母细胞瘤的病变。组织学显示出一个连续的谱系，其中富含网状纤维的梭形细胞区域的“胶质肉瘤”与仅含有小梭形细胞岛和网状纤维染色的典型胶质母细胞瘤融合。胶质纤维酸性蛋白（GFAP）、S100蛋白和α平滑肌肌动蛋白（ASMA）的免疫细胞化学显示，“胶质肉瘤”和胶质母细胞瘤网状纤维较少区域的大多数细胞表达S100蛋白和GFAP；许多细胞表达ASMA，一些细胞同时表达GFAP和ASMA。“胶质肉瘤”和胶质母细胞瘤富含网状纤维区域的梭形细胞最常表达ASMA，但许多细胞也表达S100蛋白和GFAP；一些细胞同时表达GFAP和ASMA。本研究结果及文献综述表明，在谱系的不同端点，胶质母细胞瘤和“胶质肉瘤”存在临床、放射学和病理学的连续性。因此，建议将大多数（如果不是全部）“胶质肉瘤”重新命名为梭形细胞胶质母细胞瘤，而不应被视为胶质瘤和肉瘤的混合体。
