Roselli R, Iacoangeli M, Scerrati M, Rossi G F
Institute of Neurosurgery, Catholic University, Rome, Italy.
Acta Neurochir Suppl (Wien). 1989;46:79-81. doi: 10.1007/978-3-7091-9029-6_19.
Quantitative tumour growth into the brain (stage of the disease) and qualitative tumour evolution in the time (progression) are the two basic aspects of the natural history of the cerebral neoplastic disease. Recently the development of neuroradiological imaging (CT and MR) and the progress in biopathology of the nervous system tumours introduced new concepts like heterogeneity of neuroepithelial tumours or evolution to anaplasia. The findings obtained in 159 neuroepithelial tumours studied with stereotactic biopsy from 1980 to 1987 are presented. Most of them were glioblastomas (n = 43; 27%) and astrocytic tumours (n = 81; 50.9%). Twenty-nine cases of fibrillary astrocytomas (35.8% of all astrocytic tumours) showed focal anaplasia (progression). In 10 out of the 43 glioblastomas (23.3%) signs of astrocytic differentiation were clearly evident (secondary glioblastoma?). Our data confirm that neuroectodermal tumours, particularly of astrocytic series, undergo progression through anaplasia, which may be at the beginning a circumscribed phenomenon (focal anaplasia). The staging of the disease (tumour growth) into cerebral nervous system in some cases can not be correctly expressed through the neuroradiological imaging. Sometime CT scan may underestimate the true extension of the lesion. On the contrary, MR may overrate the extension of the lesion. Such mistakes in evaluation of tumour staging may be corrected through seriate stereotactic biopsy.
肿瘤向脑内的定量生长（疾病分期）以及肿瘤随时间的定性演变（进展）是脑肿瘤性疾病自然史的两个基本方面。近年来，神经放射学成像（CT和MR）的发展以及神经系统肿瘤生物病理学的进展引入了一些新概念，如神经上皮肿瘤的异质性或向间变的演变。本文展示了1980年至1987年通过立体定向活检研究的159例神经上皮肿瘤的研究结果。其中大多数是胶质母细胞瘤（n = 43；27%）和星形细胞肿瘤（n = 81；50.9%）。29例纤维型星形细胞瘤（占所有星形细胞肿瘤的35.8%）表现出局灶性间变（进展）。在43例胶质母细胞瘤中的10例（23.3%）中，星形细胞分化的迹象明显（继发性胶质母细胞瘤？）。我们的数据证实，神经外胚层肿瘤，尤其是星形细胞系列的肿瘤，通过间变发生进展，间变在开始时可能是一种局限性现象（局灶性间变）。在某些情况下，通过神经放射学成像无法正确表达疾病（肿瘤生长）在中枢神经系统中的分期。有时CT扫描可能会低估病变的真实范围。相反，MR可能会高估病变的范围。通过系列立体定向活检可以纠正肿瘤分期评估中的此类错误。
