Reynier Y, Hassoun J, Vittini F, Gambarelli-Dubois D, Vigouroux R P
Neurochirurgie. 1984;30(1):1-10.
The authors present 4 operated cases of primary fibro sarcomas of the dura mater. Only, a few number of cases had been described in the literature. In Zulch's classification (1957) of 6000 brain tumors, there were 162 cases of sarcoma (i.e. 2,7%) and among sarcoma, 30 cases of fibrosarcoma of the dura mater. In according with the WHO classification of brain tumors (Zulch, 1979), the primary fibrosarcoma of the dura mater takes place in the group of meningeal sarcomas with the polymorphic cell sarcoma and the primary meningeal sarcomatosis. The pre-operative diagnosis is difficult, because neither clinical data, neither neuroradiological findings are characteristics. The prognosis of the patients with this tumor is poor, however some examples are known to have had a long post-operative survival. The association: complete surgical extirpation--post-operative radiation appears like to best treatment. Pathological examination showed in our four tumours, the features of fibroblastic sarcomas with haemorrhagic zones and foci of osteoid metaplasia. The ultra-structural study in 2 cases, confirmed the specificity of tumoral cells which did not display any histological similarity to the arachnoïdal cells. In one case, a myofibroblastic differentiation was evident, and thus, confirmed the plasticity of tumoral fibroblastic cells. The immuno-histochemical reaction of GFAP revealed reactive astrocytic areas in one case inside the immuno-histochemical sarcomatous tissue.
作者报告了4例原发性硬脑膜纤维肉瘤的手术病例。文献中仅描述过少数病例。在祖尔希(1957年)对6000例脑肿瘤的分类中,有162例肉瘤(即2.7%),其中硬脑膜纤维肉瘤30例。根据世界卫生组织脑肿瘤分类(祖尔希,1979年),原发性硬脑膜纤维肉瘤属于脑膜肉瘤组,包括多形细胞肉瘤和原发性脑膜肉瘤病。术前诊断困难,因为临床资料和神经放射学表现均无特征性。该肿瘤患者预后较差,不过已知有一些病例术后存活时间较长。联合治疗:完整手术切除加术后放疗似乎是最佳治疗方法。病理检查显示,我们的4例肿瘤具有纤维母细胞肉瘤的特征,伴有出血区和类骨质化生灶。2例的超微结构研究证实了肿瘤细胞的特异性,这些细胞与蛛网膜细胞无任何组织学相似性。在1例中,明显存在肌纤维母细胞分化,从而证实了肿瘤纤维母细胞的可塑性。免疫组化GFAP反应显示,在免疫组化肉瘤组织内的1例中存在反应性星形胶质细胞区域。