Neurological Surgery 脳神経外科42巻11号

2014年11月発行

総説

Conventional GBM vs GBMO：この2つの病態のentityは同一か否か—Update information

著者： 伊東民雄¹ 中村博彦¹ 田中伸哉² 長谷川匡³

所属機関： ¹中村記念病院脳神経外科脳腫瘍センター ²北海道大学腫瘍病理学分野 ³札幌医科大学付属病院病理部

ページ範囲：P.997 - P.1008

Ⅰ．はじめに

　Glioblastoma（GBM）は星細胞系腫瘍群で最も予後の悪い腫瘍型で，脳内を浸潤性破壊性に増殖する．90%以上は前病変なく発生するprimary GBMであるが，残りはdiffuse astrocytomaやanaplastic astrocytomaから悪性転化するsecondary GBMで，より若年層に発生する．分子生物学的にはprimary GBMはEGFRの過剰発現や増幅，PTENの欠失などが高頻度にみられるが，secondary GBMではp53変異が高率に検出される．またIDH1変異はsecondary GBMで高率にみられるが，primary GBMではほとんど認められない．

　GBMの亜型としてoligodendroglioma成分を伴う症例があり，GBM with oligodendroglial component（GBMO）と呼ばれている．GBMOはanaplastic oligoastrocytomaのastrocytic tumor部分に壊死が存在する場合，WHO 2007分類からGBMに分類されている¹¹⁾．しかし近年，通常のGBMに乏突起膠腫成分を認める腫瘍をGBMOと呼ぶ傾向が強くなり，未だGBMOの概念や予後については議論のあるところである．

　すなわちGBMOにおける腫瘍の起源や予後については，さまざまな施設より報告が相次いでいるが，未だ混沌としており一致した見解はみられていない．

　今回われわれは自験例のGBMO 9例において，種々のマーカーを免疫染色およびFISH法を行い，予後も含めてconventional GBM（cGBM）と比較検討したので報告するとともに，過去のGBMOに関する文献的考察を行い，現時点における本腫瘍の起源と予後についてまとめてみた．

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