抄録
Eleven cases of anaplastic gliomas with extraneural metastases are reported in this paper. All cases fulfilled Weiss' minimal criteria for confirmation of extraneural metastases of gliomas. The cases were analysed according to the mode of metastases such as the blood stream, ventriculoperitoneal shunt and lymphogeneous spread.
The group of metastases via the blood stream included one case of cerebral ependymoblastoma, one anaplastic astrocytoma, one glioblastoma and two medulloblastomas. Main metastatic sites of organs were the liver in four cases, bone in three, and the lungs in two. Two cases of dural invasion by glioma tissue were confirmed by operation and autopsy. Venous invasion by tumor cells was verified histologically in one case of medulloblastoma. Blood stream metastases must be taken into consideration in cases of dural invasion and/or venous invasion by tumor tissue.
Two cases of metastases via a ventriculoperitoneal shunt were observed in cases of fourth ventricle ependymoblastoma and pontine glioblastoma. Marked leptomeningeal dissemination was recognized at autopsy in both cases. The case of ependymoblastoma with distinct peritoneal metastases showed ascites 22 months after the ventriculoperitoneal shunt. Two small peritoneal metastatic deposits were found in a case of pontine glioblastoma. Metastases by the shunting procedure might occur in cases of gliomas with leptomeningeal dissemination.
The group of lymphogeneous metastasis included three cases of anaplastic astrocytomas and one case of glioblastoma. All of these cases were operated on more than twice and bone flaps were removed in the first or the following operations. Three out of four cases showed massive extracranial encroachment of growth directly through the bony defect. Metastases to cervical lymph nodes on the craniotomy side was the first manifestation of this mode of metastasis.
