LEPTOMENINGEAL DISSEMINATION OF MALIGNANT GLIOMAS - INCIDENCE, DIAGNOSIS AND OUTCOME
LEPTOMENINGEAL DISSEMINATION OF MALIGNANT GLIOMAS - INCIDENCE, DIAGNOSIS AND OUTCOME
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DOI：
10.1007/bf01476415
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发表时间：
1994-01-01
影响因子：
2.4
通讯作者：
HAYAKAWA, T
中科院分区：
文献类型：
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作者：
ARITA, N;TANEDA, M;HAYAKAWA, T
为了了解恶性胶质瘤软脑膜播散的临床病理特征，我们分析了1978年至1989年间共157例连续治疗的患者。22例患者（14%）被判定为播散。在20例患者中，在死前诊断出播散。11例患者因播散而有神经功能缺损，而其他9例无神经功能缺损的患者有CT或脊髓造影播散证据。在生命的第一个和第二个十年中观察到不孕症的高峰发生率。22例发生播散的患者平均年龄为31岁，显著低于未发生播散的患者（44.5岁）。15例患者在诊断后1年内发生播散（早期播散），其中60%的患者年龄小于30岁。所有晚期播散患者（诊断后一年以上）在播散前均接受了第二次开颅手术切除肿瘤，而15例早期播散患者均未接受。诊断后的生存期在传播的患者短，虽然统计学上不显着，比患者没有传播。所有患者的播散后生存期均有限（平均19周，范围2 - 39周）。免疫组化结果显示，播散性胶质瘤表达胶质细胞酸性蛋白低于原发性胶质瘤。我们的结果表明，播散似乎不是由于患者的生存期延长，但可能发生在恶性胶质瘤的任何时候。一些恶性胶质瘤，特别是在年轻患者中，具有在疾病的早期阶段获得适于传播的生物学特征的能力。
To understand the clinicopathology features of leptomeningeal dissemination of malignant gliomas, a total of 157 consecutive patients treated between 1978 and 1989 were analysed. Twenty-two patients (14%) were judged to have dissemination. In 20 patients, the dissemination was diagnosed antemortem. Eleven patients had neurological deficits due to dissemination, whereas the other 9 without these had CT or myelographic evidence of dissemination. The peak incidence of dessemination was seen in the first and second decades of life. The mean age of 22 patients with dissemination was 31 years, significantly lower than that (44.5 years) of patients without dissemination. Fifteen patients developed dissemination within one year after diagnosis (early dissemination), 60% of them were less than 30 years of age. All patients with late dissemination (more than one year after diagnosis) underwent a second craniotomy for tumour removal before dissemination, while none of the 15 patients with early dissemination did. Survival after diagnosis in patients with dissemination was shorter, although statistically not significant, than that of patients without dissemination. Survival after dissemination was limited in all patients (mean 19 weeks, range 2-39 weeks). Immunohistochemical study revealed that the disseminated tumour expressed less glial fibrillary acidic protein than the primary tumour.Our results suggest that dissemination does not seem to result from extended survival of the patients, but may occur at any time in malignant gliomas. Some malignant gliomas, especially in younger patients, have a capability to acquire biological characteristics suitable for dissemination in the earlier stage of the disease.