GLIOBLASTOMA (glio [ma] + grech, blastos sprout, germ + oma; synonym: gliosarkoma, multiformny spongioblastoma, multiformny glioblastoma, astrocytoma of III and IV degrees of a zlokachestvennost) — one of kinds of malignant gliomas of c. N of page.
Meets more often at men at the age of 40 — 55 years and makes 10 — 13% of all intracranial tumors.
In most cases G. strikes a great brain. It is more often localized in white matter of the seven-oval center of a frontal lobe, in upper or lower parietal segments, in a temporal share; in a knee and front department of a corpus collosum with distribution on one or both hemispheres; in the roller of a corpus collosum with growth in side ventricles and occipital shares; in a thalamus. Less often G. meets in bark where creates well outlined node. It is very seldom localized in the bridge of a brain, a spinal cord and a cerebellum. There is G. from astrocytes; more rare than cells of an oligodendrogliya or ependyma.
Macroscopic research: Of the capsule has no. Border of a tumor with tissue of a brain in places rather accurate, places indistinct. Quite often the tumor grows in a type of a wedge, top of the side ventricle reaching a wall. Has a characteristic motley appearance: yellowish-gray sites of a necrosis in the center, gray-red viable fabric on peripheries, the brown and red centers of old and fresh hemorrhages. Marrow, adjacent to a tumor, is edematous, with expanded vessels and small hemorrhages.
Microscopically G. is characterized by variability of a form and the sizes of randomly located tumor cells, polymorphism of their kernels, the centers of a necrosis, changes of vessels. G.'s cells can be spindle-shaped, roundish, multipolar, seldom star-shaped. Along with small, average size and large cells colossal multi-core cells meet. Mitoses are usual numerous patol. Cells of one type can prevail, spindle-shaped are more often. According to Ramone-and-Kakhalyu, tumor cells are impregnated poorly and changeably. In peripheral departments of G. single axons and astrocytes of quickly perishing tissue of a brain sometimes are found. The microscopic centers of a necrosis of tumoral fabric bordered with the extended cells oriented perpendicularly to borders of a tumor («pseudo-palisades») are constant. Rough proliferation of cells of an endothelium and adventitia of vessels, formation of balls are characteristic, konvolt from neogenic vessels of capillary type, vasodilatation, thrombosis of their gleam. To nuclear polymorphism of G. there corresponds high degree of a heteroploidy and consequently, cytogenetic heterogeneity of population of its cells. Are not identical on the proliferative activity: the share of the cells which are going to share fluctuates at them ranging from 8 to 20%.
Infiltrirut and destroys brain fabric, generally moving ahead between nerve fibrils. Remains disputable, G. in the direction of the course of conduction paths or intracerebral vessels grows. Often sprouts an ependyma of cerebral cavities and can sometimes give implantation metastasises on their walls and subarachnoid spaces. Regional metastasises in substance of a brain out of communication with likvoronosny ways meet. Ekstrakranialny metastasises are exclusively rare.
Meet initially multiple G. Vozmozhno formation of the centers of G. in rather high-quality astrocytomas. Sometimes in fabric G. along with its cellular elements cellular elements of sarkomatozny character meet. In the majority of such «bidermalny» tumors (see. Brain, tumors ) proliferation of a connective tissue component, apparently, reactive, but not tumoral. It is impossible to differentiate G. with high-malignant options of an oligodendroglioma and an ependymoma in some cases. The question of the differential diagnosis between G. and so-called monstrokletochny sarcoma which is characterized, as well as many G., a large number of huge multinucleate cells, is solved by means of coloring on reticulin fibers.
Clinically It is characterized by a rapid current; heavy all-brain symptoms prevail. Sometimes the tumor is shown in the form of a hemorrhagic stroke or acute focal encephalitis. The clinic and diagnosis depend on G.'s localization (see. Brain, tumors ).
Treatment Surgical. As a rule, it is combined with radiation therapy and chemotherapy. Since the full oncotomy is almost impossible in view of its infiltrative growth, one authors recommend to be limited to decompressive trepanation in combination with beam treatment and chemotherapy, others prefer perhaps fuller oncotomy together with a zone of boundary marrow, combining operation with radiation and chemotherapy.
Forecast it is adverse.
Bibliography The multivolume guide to pathological anatomy, under the editorship of A. I. Strukov, t. 2, page 435, M., 1962; Russell D. S. a. Rubinstein L. J. Pathology of tumors of the nervous system, L., 1971; S with h r o d e r R. u. a. Statistische Beitrage zum Grading der Gliome, Acta neurochir. (Wien), Bd 18, S. 186, 1968.
B. B. Arkhangelsk.