多発性神経膠腫
1976 年 16pt2 巻 3 号 p. 207-214
詳細
1976 年 16pt2 巻 3 号 p. 207-214
Three cases out of 153 histologically verified gliomas in the Department of Neurosurgery, Gunma University, were pathologically considered as multicentric gliomas. The clinical and autopsy findings were described and the pathological criteria of multicentricity of gliomas (gliomas of multifocal origin) were discussed.
1. In Case I, a 55-year-old male, discrete tumors were observed at autopsy in the right frontal and left posterior temporal lobe, respectively. The histological diagnosis was anaplastic astrocytoma. The patient died 18 months after the onset. Surgical intervention was not performed, but irradiation was given.
2. In Case 2, a 53-year-old female, hemorrhagic-necrotic masses were found in the right parietal and occipital lobe, respectively. Histologically, both tumors were anaplastic astrocytoma. Neither operation nor irradiation was given. The patient died 5 months after the onset.
3. In Case 3, a 56-year-old male, discrete tumors were found in the splenium of the corpus callosum and the cerebellar vermis. Ventriculoperitoneal shunt was performed and irradiation was given, but the patient died 3 months after the onset. Autopsy revealed that both tumors were separately situated, and histologically were glioblastomas.
4. Though a local meningeal and ependymal invasion of each tumor existed at autopsy, there were no secondary diffuse meningeal and ependymal deposits which would suggest dissemination of the growth through cerebrospinal fluid pathways. Serial sectioning of the specimens disclosed the discontinuity between each discrete tumor. Anatomical relationship of the vascular distribution of each tumor did not support the possibility of hematogeneous spread. These findings strongly suggested the multicentricity of the gliomas, as in the cases in the literature.
5. In the available literatures are listed more than 200 cases with multicentric gliomas, including 5 cases reported in Japan. Plural neoplasms within the cranial cavity are considered to be of multifocal origin when the histology of the neoplasms is different from each other, but debatable when the histology is similar. The criteria of the multicentricity of gliomas are, at present, no more than an elimination of metastasis and extension of the growth through various possible pathways. It should be improved by the further study of still unreported cases and by accumulation of future cases.
