Ogashiwa M, Maeda T, Yokoyama H, Takeuchi K, Akai K
National Center of Neurology and Psychiatry.
Gan No Rinsho. 1989 Sep;35(11):1297-307.
Morphologic features of the autopsied specimen of 22 cases with supratentorial gliomas treated by surgery, radiation and/or chemotherapy were analysed, and the characteristics of recurrence of gliomas were searched for. The cases consisted of anaplastic 12 astrocytoma and 10 glioblastoma. The results were as follows: 1) Characteristic CT findings before death were regrowth of the tumor mass or the occurrence of a new enhanced lesion in 21 out of 22 cases. The enhanced lesion showing regrowth of the tumor located in the same site as the previous tumor mass in 21 cases. The new enhanced lesion resulting from a trans-or subependymal tumor spread, was seen in the ventricular wall, and these findings were a characteristic feature of the recurrence of gliomas. 2) Modes of extension of the tumor were subdivided into 3 types. One was the expansive or infiltrative type caused by regrowth of the residual tumor. In the second pattern, a spread of tumor cells occurred along the myelinated fiber tracts to the brain stem (60%), or to the contralateral cerebral hemisphere through the corpus callosum (50%). The third mode of tumor propagation was cerebrospinal fluid seeding with intraventricular or subarachnoid tumor regrowth (45%). 3) Characteristic histological findings shown in the original tumor bed were those of increased cellularity with endothelial proliferation, widespread necrosis with occlusion of the blood vessels, occurrence of the gemistocytic astrocytes and large bizarre cells. Thickening of wall of the blood vessels due to effect by radiation was followed by occlusion of the blood vessels. Large necrosis in the tumor tissue was caused by those process and others. Necrotic area was mainly circumscribed and corresponded to the territory of the vessels. One of the specific findings in the morphological changes of the tumor cells was giant cell formation which were monstrous cell, giant cell (12 cases out of 22), and gemistocytic cell (in all cases). These specific cells were supposed to the degenerative changes of the tumor cells exposed while withstanding such adverse conditions as hypoxia, radiation and chemotherapy. 4) Infiltration distant from the primary lesion which were defined only by microscopical examination was demonstrated as both through myelinated fiber tracts in 8 cases and through perivascular spaces in 2 cases. Reinvasion of the tumor cells from the subarachnoid spaces to the brain parenchyma was along the Virchow-Robins spaces of the penetrating blood vessels in the latter cases.(ABSTRACT TRUNCATED AT 400 WORDS)
对22例接受手术、放疗和/或化疗的幕上胶质瘤尸检标本的形态学特征进行分析，探寻胶质瘤复发的特点。病例包括12例间变性星形细胞瘤和10例胶质母细胞瘤。结果如下：1）死亡前特征性CT表现为22例中有21例肿瘤块再生长或出现新的强化病灶。21例肿瘤再生长的强化病灶位于与先前肿瘤块相同部位。因经室管膜或室管膜下肿瘤播散导致的新强化病灶见于脑室壁，这些表现是胶质瘤复发的特征性表现。2）肿瘤的扩展方式分为3种类型。一种是残留肿瘤再生长引起的膨胀性或浸润性类型。第二种模式是肿瘤细胞沿有髓纤维束扩散至脑干（60%），或通过胼胝体扩散至对侧大脑半球（50%）。肿瘤传播的第三种模式是脑脊液播散伴脑室内或蛛网膜下腔肿瘤再生长（45%）。3）原肿瘤床显示的特征性组织学表现为细胞增多伴内皮细胞增生、广泛坏死伴血管闭塞、肥胖型星形胶质细胞和大的奇异细胞出现。放疗作用导致血管壁增厚，随后血管闭塞。肿瘤组织中的大片坏死是由这些过程及其他因素引起的。坏死区域主要为局限性，与血管分布区域相对应。肿瘤细胞形态学改变的特异性表现之一是巨细胞形成，即怪异细胞、巨细胞（22例中有12例）和肥胖型细胞（所有病例均有）。这些特异性细胞被认为是肿瘤细胞在耐受缺氧、放疗和化疗等不利条件时发生的退行性改变。4）仅通过显微镜检查确定的远离原发灶的浸润，8例经有髓纤维束，2例经血管周围间隙证实。在后一种情况下，肿瘤细胞从蛛网膜下腔再侵入脑实质是沿着穿通血管的维尔肖-罗宾间隙进行的。（摘要截短于400字）
