Identification of two distinct subpopulations in a ganglioneuroblastoma: Lack of co-localization of vasoactive intestinal polypeptide and calcitonin in ganglionic cells at the ultrastructural level
✍ Scribed by Schellscheidt, J�rn ;Baas, Stephanie ;Schmid, Kurt W. ;Vormoor, Josef ;Zimmer, Klaus-Peter
- Publisher
- John Wiley and Sons
- Year
- 2003
- Tongue
- English
- Weight
- 138 KB
- Volume
- 41
- Category
- Article
- ISSN
- 0098-1532
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✦ Synopsis
tion of supratentorial lesions in NB patients with subdiaphragmatic primaries may be more plausibly explained by arterial embolization, rather than by seeding through the Batson's plexus or the cerebrospinal fluid. Thus, NB would display a predilection to spread to the cerebral hemispheres supplied by the middle cerebral artery.
The present observations have confirmed the low incidence of brain metastases as a complication of metastatic stage 4 disease. The median time from initial diagnosis to the detection of brain metastases of 19 months is similar to that in larger study populations (i.e., 13-20 months) [1,[5][6][7].
Chemotherapeutic agents may not be able to cross the blood-brain-barrier [8], so that the brain may provide a ''sanctuary'' for malignant disease. Because lumbar puncture is not a routine test in patient evaluation, we could not address the possibility that leptomeningeal and brain metastases occurred concomitantly. Nevertheless, others have suggested that the presence of circulating neuroblasts in patients with bone marrow disease or dural-based deposits at the time of the lumbar puncture may allow for seeding of the craniospinal axis [5]. As the survival rates from high-risk NB rise, a corresponding increased awareness of the possibility of brain metastasis, particularly via the internal carotid artery system, is prudent.