Sgouros S, Carey M, Aluwihare N, Barber P, Jackowski A
Department of Neurosurgery, Birmingham Neuroscience Centre, Queen Elizabeth Hospital, England.
Surg Neurol. 1998 Feb;49(2):197-204. doi: 10.1016/s0090-3019(97)00017-7.
Central neurocytoma was described as a well differentiated tumor of neuronal origin, distinct from ganglion cell tumors and neuroblastoma. An initially perceived benign biologic behavior has been questioned by subsequent reports of anaplastic and recurrent tumors. We report six cases of central neurocytoma, with variable clinical and pathologic features that stimulate discussion on the management of these tumors.
Of the 95 oligodendrogliomas treated in our institution in the last 40 years, three tumors were reclassified as central neurocytomas on histologic reappraisal. Three additional cases prospectively diagnosed as central neurocytomas are reported. The clinical, pathologic, and radiologic features are reviewed.
Early recurrence, not related to malignant histologic features, was noted in two patients who had not received postoperative radiotherapy. Anaplastic histologic changes were not accompanied by malignant biologic behavior in another patient. Neither patient with recurrent tumor was controlled by radiotherapy alone. Chemotherapy with carboplatin reduced tumor size temporarily in one of these patients.
An entirely benign nature for this tumor is questioned and it appears that there may be malignant variants. Surgery should aim for maximum possible excision, as the location of the tumor allows. The role of postoperative radiotherapy remains controversial and may be considered in cases of subtotal excision of tumors with anaplastic histologic features. Chemotherapy may be of benefit in cases recurring despite surgery and radiotherapy.
中枢神经细胞瘤被描述为一种起源于神经元的高分化肿瘤，有别于神经节细胞瘤和神经母细胞瘤。其最初被认为的良性生物学行为已受到后续间变性和复发性肿瘤报道的质疑。我们报告6例中枢神经细胞瘤病例，其临床和病理特征各异，引发了对这些肿瘤治疗方法的讨论。
在过去40年里，我们机构治疗的95例少突胶质细胞瘤中，有3例经组织学重新评估后被重新分类为中枢神经细胞瘤。另外报告了3例前瞻性诊断为中枢神经细胞瘤的病例。对其临床、病理和放射学特征进行了回顾。
2例未接受术后放疗的患者出现早期复发，这与恶性组织学特征无关。另1例患者的间变性组织学改变并未伴有恶性生物学行为。2例复发患者均未仅通过放疗得到控制。其中1例患者使用卡铂化疗使肿瘤大小暂时缩小。
该肿瘤完全良性的性质受到质疑，似乎可能存在恶性变体。手术应尽可能达到最大程度切除，前提是肿瘤位置允许。术后放疗的作用仍存在争议，对于组织学特征为间变性的肿瘤次全切除病例可考虑进行放疗。对于尽管进行了手术和放疗仍复发的病例，化疗可能有益。
