Tanaka Akio
Department of Radiology, Brain Attack Center Oota Memorial Hospital, 3-6-28 Okinogami, Fukuyama, Hiroshima 720-0825, Japan.
Radiat Med. 2006 Jul;24(6):482-92. doi: 10.1007/s11604-006-0051-0.
The most common primary brain tumors in Japanese adults are meningiomas, gliomas, pituitary adenomas, and schwannomas, which together account for 84.0% of all primary brain tumors. The typical imaging findings of these tumors are well known by radiologists; therefore, the clinical and pathological issues, including terminology, genetics, and relation to hormones are discussed in this article. Other diseases important for the differential diagnoses are also mentioned. The molecular genetic analysis of brain tumors has recently become important. For instance, genetic analysis is important for differentiating oligodendroglial tumors from astrocytic tumors, and the gene mutation predicts response to chemotherapy for anaplastic oligodendrogliomas. Background factors such as hormones, history of cranial irradiation, and medications influence oncogenesis, tumor growth, and tumor appearances as seen by imaging modalities. A differential diagnosis with knowledge of the above may have some advantages over diagnoses based on imaging findings alone. Nonneoplastic diseases such as abscesses and demyelinating diseases may mimic gliomas. Pituitary adenomas may be confused with nonneoplastic conditions such as physiological hypertrophy and Rathke's cleft cyst. Such misdiagnoses would result in a treatment protocol very different from what would be suitable. Such conditions should be carefully distinguished from neoplasms.
日本成年人中最常见的原发性脑肿瘤是脑膜瘤、胶质瘤、垂体腺瘤和神经鞘瘤，它们合计占所有原发性脑肿瘤的84.0%。放射科医生对这些肿瘤的典型影像学表现非常熟悉；因此，本文将讨论这些肿瘤的临床和病理问题，包括术语、遗传学以及与激素的关系。还会提及对鉴别诊断很重要的其他疾病。脑肿瘤的分子遗传学分析近来变得很重要。例如，基因分析对于区分少突胶质细胞瘤和星形细胞瘤很重要，而且基因突变可预测间变性少突胶质细胞瘤对化疗的反应。激素、头部放疗史和药物等背景因素会影响肿瘤的发生、生长以及影像学检查所见的肿瘤表现。了解上述情况进行鉴别诊断可能比单纯基于影像学表现的诊断更具优势。非肿瘤性疾病如脓肿和脱髓鞘疾病可能会酷似胶质瘤。垂体腺瘤可能会与生理性肥大和拉克氏囊肿等非肿瘤性情况相混淆。此类误诊会导致治疗方案与合适的方案大不相同。应仔细将这些情况与肿瘤区分开来。
