Kleinschmidt-Demasters B K
Department of Pathology and Neurology, University of Colorado Health Sciences Center, Denver 80262, USA.
Hum Pathol. 1996 Feb;27(2):197-201. doi: 10.1016/s0046-8177(96)90376-7.
Two cases of glioblastoma multiforme (GBM) diffusely metastatic to bone marrow are presented; both patients developed back pain, thrombocytopenia, and hemorrhagic diatheses from their diffuse bony disease. In one patient the intracranial and extracranial symptoms were synchronous in their presentation. Both patients had known dural involvement by GBM at the time of craniotomy and dural venous invasion microscopically. Tumor infiltration of dura and dural vessels is a significant mechanism for extracranial spread and should be noted by surgical pathologists in their reports if it is found. Although cases of metastatic GBM have been uncommon in the past, especially without antecedent surgery or ventriculoperitoneal shunt placement, better control of local disease may enhance the possibility of extracranial spread in the future from GBM. The finding of dural invasion by GBM either at surgery or microscopically should prompt oncologists to initiate at least a limited metastatic work-up for this subset of GBM patients.
本文报告了两例多形性胶质母细胞瘤（GBM）骨髓弥漫性转移的病例；两名患者均因弥漫性骨病出现背痛、血小板减少和出血倾向。其中一名患者的颅内和颅外症状在表现上是同步的。两名患者在开颅手术时均已知GBM侵犯硬脑膜，且显微镜下可见硬脑膜静脉受侵。硬脑膜和硬脑膜血管的肿瘤浸润是颅外扩散的重要机制，如果发现，手术病理学家应在报告中予以注明。尽管过去转移性GBM病例并不常见，尤其是在没有先行手术或脑室腹腔分流置入的情况下，但更好地控制局部疾病可能会增加未来GBM颅外扩散的可能性。在手术或显微镜下发现GBM侵犯硬脑膜，应促使肿瘤学家至少对这部分GBM患者开展有限的转移灶检查。
