女性生殖系统恶性肿瘤的主要定位和向脑转移扩散的方式

S. V. Chernov, S. E. Krasilnikov, J. A. Rzaev, A. Kalinovskiy, A. V. Zotov, A. Kasymov, E. Gormolysova, E. Uzhakova, M. K. Antaev
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From 2013 to 2020, a total number of 448 patients with metastatic brain tumors from different cancers were operated on at the Department of Neuro‑Oncology of the Federal Center of Neurosurgery (Novosibirsk). Metastases of tumors of the female reproductive system were presented in 32 (7.1 %) cases. The average age was 55.1 (27–72) years. Ovarian cancer was the primary focus in 24 (5.3 %) cases, endometrial cancer – in 6 (1.3 %), cervical cancer – in 2 (0.4 %). Occipital lobe was the most often location for the metastases in the brain and occurred in 10 (31.3 %) patients. Subtentorial localization was on the second place and noted in 9 (28.1 %) cases. Of these, metastases to the cerebellum were registered in 8 cases and in 1 case the metastasis was located in the brain stem.Results. Gross total removal of metastasis was achieved in all 32 patients. Of 9 cases with subtentorial localization of metastasis, only 1 patient had lung metastases verified. 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摘要

背景。女性生殖系统癌症向大脑转移的情况很少见,约占所有中枢神经系统转移病例的 5%。最常见的转移灶是卵巢癌(0.49-6.1%)、子宫内膜癌(0.4-1.2%)和宫颈癌(0.3-0.9%)。这类肿瘤向脑部转移的主要定位和扩散方式可能不同于肺癌、乳腺癌、肾癌或黑色素瘤。分析女性生殖系统恶性肿瘤脑转移的定位以及恶性细胞从原发灶向中枢神经系统扩散的方式。从2013年到2020年,联邦神经外科中心(新西伯利亚)神经肿瘤部共为448名不同癌症的转移性脑肿瘤患者实施了手术。女性生殖系统肿瘤转移有32例(7.1%)。平均年龄为 55.1(27-72)岁。卵巢癌是 24 例(5.3%)病例的主要病灶,子宫内膜癌 - 6 例(1.3%),宫颈癌 - 2 例(0.4%)。枕叶是脑转移最常见的部位,有 10 例(31.3%)患者发生了枕叶转移。其次是椎体下叶,有 9 例(28.1%)。其中,8 例转移至小脑,1 例转移至脑干。所有 32 例患者都实现了转移瘤的彻底切除。在 9 例转移灶位于脑干下的病例中,只有 1 例患者的肺转移得到证实。16例患者术后神经症状消退,病情好转。出院时的 Karnovsky 评分为 85.2。女性生殖系统恶性肿瘤的转移部位中,胸膜下占主要位置之一。这是因为肿瘤细胞可从盆腔通过巴特森椎体静脉系统直接扩散到小脑或脑干,而不经肺血液循环和肺部扩散。在早期诊断域下转移性脑肿瘤和转诊这些患者进行神经外科治疗时,应考虑到这一点。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Predominant localization and ways of metastatic dissemination to the brain of malignant tumors of the female reproductive system
Background. Metastases of the female reproductive system cancer to the brain are rare and reach about 5 % of all cases with metastatic lesions of the central nervous system. The most common metastases are ovarian cancer (0.49–6.1 %), endometrial cancer (0.4–1.2 %) and cervical cancer (0.3–0.9 %). The predominant localization and ways of spreading metastases to the brain in this category of tumors may differ from lung cancer, breast cancer, kidney cancer or melanoma.Aim. To analyze the localization of brain metastases of malignant tumors of the female reproductive system and the ways of dissemination of malignant cells from the primary focus to the central nervous system.Materials and methods. From 2013 to 2020, a total number of 448 patients with metastatic brain tumors from different cancers were operated on at the Department of Neuro‑Oncology of the Federal Center of Neurosurgery (Novosibirsk). Metastases of tumors of the female reproductive system were presented in 32 (7.1 %) cases. The average age was 55.1 (27–72) years. Ovarian cancer was the primary focus in 24 (5.3 %) cases, endometrial cancer – in 6 (1.3 %), cervical cancer – in 2 (0.4 %). Occipital lobe was the most often location for the metastases in the brain and occurred in 10 (31.3 %) patients. Subtentorial localization was on the second place and noted in 9 (28.1 %) cases. Of these, metastases to the cerebellum were registered in 8 cases and in 1 case the metastasis was located in the brain stem.Results. Gross total removal of metastasis was achieved in all 32 patients. Of 9 cases with subtentorial localization of metastasis, only 1 patient had lung metastases verified. Regression of neurological symptoms and improvement of the condition were noted in 16 patients after surgery. The Karnovsky performance score at the time of discharge was 85.2.Conclusion. The subtentorial location of metastases in malignant tumors of the female reproductive system occupies one of the leading places. This is because the dissemination of tumor cells from the pelvis can occur through a Batson vertebral venous system directly to the cerebellum or brain stem without the pulmonary blood circulation and lung dissemination. This should be taken into account for the early diagnosis of subtentorial metastatic brain tumors and referral of these patients for neurosurgical treatment.
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