神経膠腫の再発機序に関する形態学的研究 : 腫瘍細胞の進展とangiogenesisを中心に

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Morphological features of the autopsied specimens of 15 adult patients with supratentorial gliomas were analysed and the characteristics of recurrence of gliomas were searched for. The correlation between the computed tomography (CT) findings before death and the microscopic findings of a whole mount section of the brain was also analysed. The cases consisted of 2 grade II, 7 grade III and 6 grade IV astrocytomas. The characteristic CT findings before death were regrowth of the tumor mass or the occurrence of a new enhanced lesion in 14 out of 15 patients. The enhanced lesion showing regrowth of the tumor was located in the same site as the previous tumor mass. The new enhanced lesion, resulting in a trans- or subependymal tumor spread, was seen in the ventricular wall, and this was a characteristic feature of the recurrence of gliomas. In morphological analysis, tumor regrowth and recurrent tumor cell infiltration into the brain parenchyma occurred in several patterns. One was the extending mode caused by regrowth of the residual tumor in spite of adjuvant therapy. CT scan correctly showed such tumor recurrence as an enhanced lesion, especially as a ring or nodular enhancement. In the second pattern, a spread of tumor cells occurred along the interfiber spaces to the brain stem, or to the contralateral cerebral hemisphere through the corpus callosum. CT scan could hardly show such a type of tumor cell infiltration. The third mode of tumor propagation was cerebrospinal fluid seeding, with intraventricular or subarachnoid tumor growth. The CT scan examined before death could display the tumor invasion of the intraventricular seeding in 3 out of 8 patients. Histologically, reinvasion of the tumor cells from the subarachnoid space to the brain parenchyma was along the Virchow-Robin spaces of penetrating blood vessels. If tumor regrowth was accompanied by angiogenesis, CT scan could show the recurrence as an enhanced lesion. Marked angiogenesis occurred in the margin of the residual tumor with central necrosis due to adjuvant therapy.
日本脳神経外科学会の論文
1985-12-15

神経膠腫の再発機序に関する形態学的研究 : 腫瘍細胞の進展とangiogenesisを中心に

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