Bekaert Lien, Emery Evelyne, Levallet Guénaëlle, Lechapt-Zalcman Emmanuèle
Neurosurgery Department, Caen University Hospital, Avenue de la Côte de Nacre, 14000, Caen, France.
Department of Pathology, Caen University Hospital, Avenue de la Côte de Nacre, 14000, Caen, France.
Brain Tumor Pathol. 2017 Jan;34(1):8-19. doi: 10.1007/s10014-016-0275-3. Epub 2016 Nov 22.
Confronted with brain metastases (BM), pathologists aim to rule out a primary central nervous system (CNS) tumor and to identify or verify the primary tumor site to guide the clinician to specific therapies. Apart from morphological features, ancillary immunohistochemical analysis is the most effective tool for characterizing a metastatic neoplasm of unknown origin. A limited array of antibodies is used, taking into account relevant clinical information and the known brain tropism of lung cancer, breast cancer and melanoma. Recently, targeted therapies have enriched the therapeutic arsenal, in particular for patients with non-small cell lung cancer or melanoma and for patients carrying molecular anomalies. These therapies can lead to a substantial tumor response, brain metastases included, which justifies rapid determination of a molecular profile. To combine different tools and provide timely results, good tumor sample management and careful attention at the pre-analytical phase are critical. Appropriate strategies for molecular and immunohistochemical analysis are needed to identify theranostic markers. This article aims to review the anatomopathological diagnostic approach for BM in the age of targeted therapies.
面对脑转移瘤（BM），病理学家旨在排除原发性中枢神经系统（CNS）肿瘤，并识别或确认原发性肿瘤部位，以指导临床医生进行特定治疗。除形态学特征外，辅助免疫组化分析是表征不明来源转移性肿瘤的最有效工具。考虑到相关临床信息以及肺癌、乳腺癌和黑色素瘤已知的脑嗜性，会使用有限的一组抗体。最近，靶向治疗丰富了治疗手段，特别是对于非小细胞肺癌或黑色素瘤患者以及携带分子异常的患者。这些治疗可导致显著的肿瘤反应，包括脑转移瘤，这使得快速确定分子谱成为合理之举。为了结合不同工具并及时得出结果，良好的肿瘤样本管理以及在分析前阶段的仔细关注至关重要。需要适当的分子和免疫组化分析策略来识别治疗诊断标志物。本文旨在综述靶向治疗时代BM的解剖病理学诊断方法。
