胶质母细胞瘤的新概念

New Concept of Glioblastoma

介绍胶质母细胞瘤(GBM)新概念。许多年来,以肿瘤发生的胚胎学说为基础,将一些高度恶性的神经上皮肿瘤,命名为胶质母细胞瘤(Glioblastoma),亦称多形性胶质母细胞瘤(Glioblastoma multifome)。由它分化成星形细胞肿瘤、室管膜肿瘤和少枝胶质肿瘤。Kemohan(1949)等发现该肿瘤为星形细胞肿瘤特征,将此肿瘤改称为星形细胞瘤Ⅳ级。目前,除用电镜、免疫组化方法证实大多数GBM属于星形细胞肿瘤外,并以大量临床治疗结果及基因学研究确定GBM为星形细胞肿瘤的本质。(1)从低级别星形细胞肿瘤恶变而来的称为继发性GBM(P53阳性,平均年龄为39岁)。(2)大年龄患者一开始(de novo)就形成的称为原发性GBM(P53极少阳性,平均年龄为55岁)。(3)由众多的多核巨细胞组成的称为巨细胞性GBM。(4)胶质母细胞瘤中出现除肿瘤血管以外的间叶成分的肿瘤,称为胶质肉瘤,这几个GBM类型比继发性GBM具有更复杂的基因学改变和更差的预后。GBM需与间变性少枝胶质瘤及间变性室管膜瘤相鉴别,后两者有完全不同的基因学改变和较好的预后。

Many years ago, based on the embryonic theory of tumor pathogenesis, most of the highly malignant neuroepithelial tumors were termed glioblastoma, or glioblastoma multiforme (GBM). It was thought that they could differentiate into the astrocytic, oligodendroglial and ependymaglial tumors. Kernohan (1949) found that GBM have characteristics of astrocytic tumors and GBM was classified as grade IV astrocytoma. Recently, the astrocytomatous entity of most GBM was confirmed not only by electronic microscope and immunohistological stain, but also by numerous results of clinical and genetic studies. (1) The term 'secondary GBM (characterized by p53 positive, and a mean age of 39 years) is used to define the tumor developed from the malignant transformation of low grade astrocytoma. (2) The term 'primary GBM (characterized by fewer P53 positive and a mean age of 55 years) was used for the tumor developed de novo in the older patients. (3) The term giant cell GBM is used for the tumor consists of numerous multinuclear giant cells. (4) The term gliosarcoma is used for glioblastoma having mesenchymal tumor elements without tumor angiogenesis. These types of GBM presented more complicated genetic changes and carry worse prognosis than the secondary GBM. GBM must be differentiated from the anaplastic oligodendrogliomas and anaplastic ependymomas, the latter two types of tumors have completely different genetic changes and have better prognosis.