Tumores do tronco cerebral: estudo anatomopatológico em 35 casos de necrópsia

Lancellotti, Carmen Lúcia Penteado; Longo, Maria Antonieta; Onozuka, Angela Pires; Oliveira, Carlos Pereira de; Carreira, Antonio Barros

doi:10.1590/S0004-282X1989000300011

Resumos

Os tumores do tronco cerebral são raros e geralmente tratados sem diagnóstico histopatológico. Sua incidência varia na literatura entre 1,09% e 17,5% dos tumores cerebrais. O objetivo do trabalho foi relatar a casuísti desses tumores em 28500 necrópsias realizadas de 1952 a 1985 no Departamento de Anatomia Patológica da Santa Casa de São Paulo. Enfatizamos os aspectos neuropatológicos, comparamos nossos casos com os de outras séries e salientamos os tumores mais observados nessa região, com a finalidade de procurar contribuir para melhor abordagem terapêutica. Utilizamos alguns dados clínicos e, através do exame anatomopatológico, localizamos o tumor no tronco cerebral sendo o diagnóstico microscópico estabelecido segundo os critérios da Organização Mundial da Saúde. Dos 428 tumores intracranianos observados, 35 estavam localizados no tronco cerebral. Foram aqui incluídos os tumores próprios do tronco cerebral e as metástases e excluídos os tumores que infiltravam o tronco. A maior incidência ocorreu na primeira década e a causa de óbito predominante foi edema cerebral. A localização preferencial foi a ponte e o tumor mais freqüente foi o glioblas-tomia multiforme (19 casos). As metástases ficaram em segundo lugar na freqüência (9 casos), na maioria dos casos de origem pulmonar. Apesar de alguns autores se posicionarem contra a biópsia de tumor nessa região, baseando-se no alto risco cirúrgico, discordamos dessa opinião, pois acreditamos que, frente ao diagnóstico de glioma, será importante a caracterização ou não de malignidade. Ainda, não devemos deixar de considerar os diagnósticos diferenciais de processo expansivo no tronco. Enfim, com o diagnóstico anatomopatológico de glioma ou de uma das possibilidades aventadas, o procedimento terapêutico poderá ser mais adequado.

Brain stem tumors are rare and are usually treated without histological diagnosis. Its incidence varies in literature between 1.09% and 17.5% of all cerebral tumors. The objective of our study is to present a casuistic of these tumors in 28500 necropsies performed from 1952 till 1985 at the Department of Pathology, Santa Casa Hospital, São Paulo. We emphasize neuropathology aspects, and compare our cases with those of other series. Also, we point out those tumors which are most frequent in this region, with the aim of possibly contributing to a better therapeutic approach. We used some clinical data and pathological diagnosis, and localized the tumor in the brain stem. Its microscopic diagnosis was determined according to the World Health Organization criterion. Among 428 intracranial tumors observed, 35 were localized in the brain stem. Intrinsic tumors and metastasis were included, and excluded those tumors which infiltrated the brain stem. Greatest incidence occured in the first decade and cerebral edema was the predominant cause of death. Preferential topography was in the pons and the most frequent tumor was glioblastoma multiformis (19 cases). Metastasis ranked second (9 cases), being mostly from lungs. Some authors oppose tumor biopsy in this region because of high surgical risk. We do not agree with this opinion. We believe that the diagnosis of glioma is important to rule out the characteristics of malignancy. We can not leave without considering the diagnosis of other pathologies which can cause expansion in the brain stem. Therapeutical approach can be more adequate with the histological diagnosis of glioma or of other possibilities as shown here.

Tumores do tronco cerebral: estudo anatomopatológico em 35 casos de necrópsia

Brain stem tumors: anatomo-pathologic study of 35 necropsy cases

Carmen Lúcia Penteado Lancellotti^I; Maria Antonieta Longo^II; Angela Pires Onozuka^III; Carlos Pereira de Oliveira^IV; Antonio Barros Carreira^V

^IDepartamento de Patologia (DP) do Hospital Central da Santa Casa de São Paulo (SCSP): Professora Associada da Faculdade de Ciências Médicas da SCSP

^IIDepartamento de Patologia (DP) do Hospital Central da Santa Casa de São Paulo (SCSP): Médica Anatomopatologista do Instituto Butantã de São Paulo e Ex-Residente do DPSCSP

^IIIDepartamento de Patologia (DP) do Hospital Central da Santa Casa de São Paulo (SCSP): Ex-Residente do DPSCSP

^IVDepartamento de Patologia (DP) do Hospital Central da Santa Casa de São Paulo (SCSP): Médico Neurologista e Ex-Residente do Departamento de Neurologia da SCSP

^VDepartamento de Patologia (DP) do Hospital Central da Santa Casa de São Paulo (SCSP): Ex-Residente de 4º. ano do Departamento de Neurocirurgia da SCSP

RESUMO

Os tumores do tronco cerebral são raros e geralmente tratados sem diagnóstico histopatológico. Sua incidência varia na literatura entre 1,09% e 17,5% dos tumores cerebrais. O objetivo do trabalho foi relatar a casuísti desses tumores em 28500 necrópsias realizadas de 1952 a 1985 no Departamento de Anatomia Patológica da Santa Casa de São Paulo. Enfatizamos os aspectos neuropatológicos, comparamos nossos casos com os de outras séries e salientamos os tumores mais observados nessa região, com a finalidade de procurar contribuir para melhor abordagem terapêutica. Utilizamos alguns dados clínicos e, através do exame anatomopatológico, localizamos o tumor no tronco cerebral sendo o diagnóstico microscópico estabelecido segundo os critérios da Organização Mundial da Saúde. Dos 428 tumores intracranianos observados, 35 estavam localizados no tronco cerebral. Foram aqui incluídos os tumores próprios do tronco cerebral e as metástases e excluídos os tumores que infiltravam o tronco. A maior incidência ocorreu na primeira década e a causa de óbito predominante foi edema cerebral. A localização preferencial foi a ponte e o tumor mais freqüente foi o glioblas-tomia multiforme (19 casos). As metástases ficaram em segundo lugar na freqüência (9 casos), na maioria dos casos de origem pulmonar. Apesar de alguns autores se posicionarem contra a biópsia de tumor nessa região, baseando-se no alto risco cirúrgico, discordamos dessa opinião, pois acreditamos que, frente ao diagnóstico de glioma, será importante a caracterização ou não de malignidade. Ainda, não devemos deixar de considerar os diagnósticos diferenciais de processo expansivo no tronco. Enfim, com o diagnóstico anatomopatológico de glioma ou de uma das possibilidades aventadas, o procedimento terapêutico poderá ser mais adequado.

SUMMARY

Brain stem tumors are rare and are usually treated without histological diagnosis. Its incidence varies in literature between 1.09% and 17.5% of all cerebral tumors. The objective of our study is to present a casuistic of these tumors in 28500 necropsies performed from 1952 till 1985 at the Department of Pathology, Santa Casa Hospital, São Paulo. We emphasize neuropathology aspects, and compare our cases with those of other series. Also, we point out those tumors which are most frequent in this region, with the aim of possibly contributing to a better therapeutic approach. We used some clinical data and pathological diagnosis, and localized the tumor in the brain stem. Its microscopic diagnosis was determined according to the World Health Organization criterion. Among 428 intracranial tumors observed, 35 were localized in the brain stem. Intrinsic tumors and metastasis were included, and excluded those tumors which infiltrated the brain stem. Greatest incidence occured in the first decade and cerebral edema was the predominant cause of death. Preferential topography was in the pons and the most frequent tumor was glioblastoma multiformis (19 cases). Metastasis ranked second (9 cases), being mostly from lungs. Some authors oppose tumor biopsy in this region because of high surgical risk. We do not agree with this opinion. We believe that the diagnosis of glioma is important to rule out the characteristics of malignancy. We can not leave without considering the diagnosis of other pathologies which can cause expansion in the brain stem. Therapeutical approach can be more adequate with the histological diagnosis of glioma or of other possibilities as shown here.

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1. Albright AL, Price RA, Guthkelch AN - Brain stem gliomas of children: a clinicopatho-logical study. Cancer 52: 2313, 1983.
2. Alpers BJ Yaskin JC - Gliomas of the pons: clinical and pathologic characteristics. Arch Neurol Psychiat 41: 435, 1939.
3. Baghai P, Uries JK, Bechtel PC - Retromastoid approach for biopsy of brain stem tumors. Neurosurgery 10: 574, 1982.
4. Barnett HJ, Yaskin HH - Tumors involving the brain stem: a study of 90 cases arising in the brain-stem, fourth ventricle, and pineal tissue. Quart J Med 21: 265, 1952.
5. Bassoe P, Apfelback CW - Glioma of the bulb and pons: report of four cases. Arch Neurol Psychiat 14: 396, 1925.
6. Bray PF, Carter S, Taveras JM - Brain stem tumors in children. Neurology 8: 1, 1958.
7. Buckley RC - Pontine gliomas: a pathologic study and classification of twenty-five cases. Arch Pathol 9: 779, 1930.
8. Cooper IS, Kernohan JW, Winchell MC - Tumors of the medulla oblongata. Arch Neurol Psychiat 67: 269, 1952.
9. Ellison PH, Hanson PA - Herpes simplex: a possible cause of brain stem encephalitis. Pediatrics 59: 240, 1977.
10. Gibbs FA - Frequency with which tumors in various parts of brain produce certain symptoms. Arch Neurol Psychiat 28: 969, 1932.
11. Golden GS, Ghatak NR, Hirano A, French JH - Malignant glioma of the brain-stem: a clinicopathological analysis of 13 cases. J Neurol Neurosurg Psychiat 35: 732, 1972.
12. Hare CC, Wolf A - Intramedullary tumors of the brain stem. Arch Neurol Psychiat 32:1230, 1934.
13. Keith HM, Craig N, Kernohan JW - Brain tumors in children. Pediatrics 3: 839, 1949.
14. Kernohan JW, Sayre GP - Tumors of the central nervous system. Atlas of Tumor Pathology, Fase 35 Armed Forces Institute of Pathology. Washington, 1952.
15. Lassman LP, Arjona VE - Pontine gliomas of childhood Lancet 1: 913, 1967.
16. Lessel S, Ferris EJ, Feldman RG, Hoyt WF - Brain stem arteriovenous malformations. Arch Ophthalmol 86: 255, 1971.
17. Liebner EJ, Pretto JI, Hochhauser M, Kassaraba W - Tumors of the posterior fossa in childhood and adolencence: their diagnostics and radiotherapeutic patterns. Radiology 82: 193, 1964.
18. Littman P, Jarret P, Bilaniuk LT, Rorke LB, Zimmerman RA, Bruce DA. Carabell SC, Schut L - Pediatric brain stem gliomas. Cancer 45: 2787, 1980.
19. Mantravadi RVP, Phatak R, Bellur S, Liebner EJ, Haas R - Brain stem gliomas: an autopsy study of 25 cases. Cancer 49: 1294, 1982.
20. Panitch HS, Berg BO - Brain stem tumors of childhood and adolescence. Am J Dis Child 119: 465, 1970.
21. Pool L - Gliomas in the region of the brain stem. Neurosurgery 29: 164, 1968.
22. Reigel DH, Scarff TB, Woodford JE - Biopsy of pediatric brain stem tumors. Child's Brain 5: 329, 1979.
23. Rubistein LJ - Tumors of the Central Nervous System. Armed Forces Institute of Pathology, 6 Washington, 1972.
24. Sarkari NBS, Bickerstaff ER - Relapses and remission in brain-stem tumors. Br Med J 2:21, 1969.
25. Schain RJ, Wilson G - Brain stem encephalitis with radiograf evidence of medullar enlargement. Neurology 21: 537, 1971.
26. Villani R, Gaini SM, Tomei G - Folow-up study of brain stem tumors in children. Child's Brain 1:126, 1975.
27. Walker AE, Hopple TL - Brain tumors in children. J Pediatr 35: 671, 1949.
28. White HH - Brain stem tumors occuring in adults. Neurology 13: 292, 1963.
29. Zülch KJ - Tipos Histológicos de Tumores del Sistema Nervioso Central. Organizacion Mundial de la Salud, Genebra, 1979.

Datas de Publicação

Publicação nesta coleção
06 Jun 2011
Data do Fascículo
Set 1989

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Albright AL, Price RA, Guthkelch AN - Brain stem gliomas of children: a clinicopatho-logical study. Cancer 52: 2313, 1983.

[2] 2. Alpers BJ Yaskin JC - Gliomas of the pons: clinical and pathologic characteristics. Arch Neurol Psychiat 41: 435, 1939.

[3] 3. Baghai P, Uries JK, Bechtel PC - Retromastoid approach for biopsy of brain stem tumors. Neurosurgery 10: 574, 1982.

[4] 4. Barnett HJ, Yaskin HH - Tumors involving the brain stem: a study of 90 cases arising in the brain-stem, fourth ventricle, and pineal tissue. Quart J Med 21: 265, 1952.

[5] 5. Bassoe P, Apfelback CW - Glioma of the bulb and pons: report of four cases. Arch Neurol Psychiat 14: 396, 1925.

[6] 6. Bray PF, Carter S, Taveras JM - Brain stem tumors in children. Neurology 8: 1, 1958.

[7] 7. Buckley RC - Pontine gliomas: a pathologic study and classification of twenty-five cases. Arch Pathol 9: 779, 1930.

[8] 8. Cooper IS, Kernohan JW, Winchell MC - Tumors of the medulla oblongata. Arch Neurol Psychiat 67: 269, 1952.

[9] 9. Ellison PH, Hanson PA - Herpes simplex: a possible cause of brain stem encephalitis. Pediatrics 59: 240, 1977.

[10] 10. Gibbs FA - Frequency with which tumors in various parts of brain produce certain symptoms. Arch Neurol Psychiat 28: 969, 1932.

[11] 11. Golden GS, Ghatak NR, Hirano A, French JH - Malignant glioma of the brain-stem: a clinicopathological analysis of 13 cases. J Neurol Neurosurg Psychiat 35: 732, 1972.

[12] 12. Hare CC, Wolf A - Intramedullary tumors of the brain stem. Arch Neurol Psychiat 32:1230, 1934.

[13] 13. Keith HM, Craig N, Kernohan JW - Brain tumors in children. Pediatrics 3: 839, 1949.

[14] 14. Kernohan JW, Sayre GP - Tumors of the central nervous system. Atlas of Tumor Pathology, Fase 35 Armed Forces Institute of Pathology. Washington, 1952.

[15] 15. Lassman LP, Arjona VE - Pontine gliomas of childhood Lancet 1: 913, 1967.

[16] 16. Lessel S, Ferris EJ, Feldman RG, Hoyt WF - Brain stem arteriovenous malformations. Arch Ophthalmol 86: 255, 1971.

[17] 17. Liebner EJ, Pretto JI, Hochhauser M, Kassaraba W - Tumors of the posterior fossa in childhood and adolencence: their diagnostics and radiotherapeutic patterns. Radiology 82: 193, 1964.

[18] 18. Littman P, Jarret P, Bilaniuk LT, Rorke LB, Zimmerman RA, Bruce DA. Carabell SC, Schut L - Pediatric brain stem gliomas. Cancer 45: 2787, 1980.

[19] 19. Mantravadi RVP, Phatak R, Bellur S, Liebner EJ, Haas R - Brain stem gliomas: an autopsy study of 25 cases. Cancer 49: 1294, 1982.

[20] 20. Panitch HS, Berg BO - Brain stem tumors of childhood and adolescence. Am J Dis Child 119: 465, 1970.

[21] 21. Pool L - Gliomas in the region of the brain stem. Neurosurgery 29: 164, 1968.

[22] 22. Reigel DH, Scarff TB, Woodford JE - Biopsy of pediatric brain stem tumors. Child's Brain 5: 329, 1979.

[23] 23. Rubistein LJ - Tumors of the Central Nervous System. Armed Forces Institute of Pathology, 6 Washington, 1972.

[24] 24. Sarkari NBS, Bickerstaff ER - Relapses and remission in brain-stem tumors. Br Med J 2:21, 1969.

[25] 25. Schain RJ, Wilson G - Brain stem encephalitis with radiograf evidence of medullar enlargement. Neurology 21: 537, 1971.

[26] 26. Villani R, Gaini SM, Tomei G - Folow-up study of brain stem tumors in children. Child's Brain 1:126, 1975.

[27] 27. Walker AE, Hopple TL - Brain tumors in children. J Pediatr 35: 671, 1949.

[28] 28. White HH - Brain stem tumors occuring in adults. Neurology 13: 292, 1963.

[29] 29. Zülch KJ - Tipos Histológicos de Tumores del Sistema Nervioso Central. Organizacion Mundial de la Salud, Genebra, 1979.