1. Out of 2000 cases of autopsy, performed in the First Department of Pathology, School of Medicine, Gunma University duiring the 9 years' period from April 1959 through June 1968, 71 had metastatic cerebro-meningeal tumor. This accounts for 3.6% of the total autopsy cases, and 14.6% of malignant tumor cases (excluding leukemic cases) which underwent total dissection inclusive of craniotomy.
2. Classification of the metastatic cerebro-meningeal tumors by their primarily affected-organs shows that bronchial cancer ranks the first, accounting for nearly a half of the total. And the rate of metastasis of bronchial cancer into the cerebro-meninges is 40.7%.
3. As for the localization of the metastatic foci in the meninges (dura mater and pia mater) and brain parenchyma, 12 out of the 71 cases showed the foci in the brain, 5 in the pia mater, 21 in the dura mater, and 3 in the brain and meninges.
4. Macroscopically, metastatic cerebro-meningeal tumors can be classified into 1) nodular metastasis in the brain parenchyma (type I), 2) multiple nodular metastasis in the brain parenchyma (type II), 3) diffuse meningeale carcinomatosis (type III), 4) nodular metastasis in the dura mater (type IV), and 5) infiltrative metastasis in the dura mater (type V).
5. There is no significant histological difference between the metastatic cerebro-meningeal tumors and their primary tumors. Cases with metastatic foci in the brain parenchyma are characterized by loop-like stroma with rich vascularity and tendency of papillary proliferation of tumor cells.
6. The boundary between the normal and metastatic tissues is distinct in many cases on the histological level. The boundary tissues exhibits degeneration of parechyma, gliocytic reaction and formation of vascular net work. This histological reactive zone is generally narrow.
7. In some cases which has the metastatic focus in the hemisphere, the white matter is markedly swollen. Histopathologically, the lesion consists of generalized rarefaction and diminution of myelin sheath fibers in the white matter of the hemisphere, but subcortical U-fibers, corpus callowsum and capsulla interna are relatively well preserved.
8. Axon fibers show stronger resistance than myelin sheath fibers. Dark stained atrophied nuclei are prominent in oligodendroglia in the foci. In general phagocytes are not involved in disintegration of the foci. Astrocytes are proliferated, exhibiting protoplasmic or plum cell form, their protoplasmic processes are swollenlike pseudopodia, or fragmented presenting a picture of clasmatodendrosis.
9. In cases of protracted clinical course, severe swelling of axon fibers, and apperance of “epitheliale Zellen”, so called by Zülch, which are devoid of cytoplasmic processes, are noticeable.
In addition there are spongiosis of white matter and its active distegration with marked proliferation of phagocytes, all of which make complication modification of the basic picture. 10. When degeneration is mild, rarefaction of parenchymal fiber structure is often emphasized in the perivascular region; but when it is severe, imbibition of protein fluid from the adventitia into the parenchyma is observed.
11. The degenerative lesion extending though the whitr matter of the metastatic hemisphere is considered, from its distribution and histopathologic features, to be edematic.
As for its genesis, blood flow disturbance and stagnant anoxia of the venous system produced by pressure of developing tumors, and disturbance in permiability of blood-brain-barrier caused by noxious factor resulting from necrotic destruction of tumor tissue are considered to be the principal causes.
12. When edematic lesion is severe, it is not only seen in the white matter but also found extending to the deep cortical layer and basal nuclei as well as to subcortical U-fibers and capsula interna.
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