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2009 | 9 | 3 | 164-182
Article title

Nowotwory ośrodkowego układu nerwowego u płodu

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EN
Foetal tumours of the central nervous system
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Abstracts
EN
Current scientific literature on a subject of foetal brain tumours, however rich, consists mainly of case reports, produced by either obstetricians – ultrasonographers or radiologists and neuropathologists. In this review, we summarize state of the art literature on that subject and we performed a meta-analysis of 92 cases from that literature and presented our own cases referred to us as to a reference centre. This centre is obstetrical and paediatric and provides a complex care for both a pregnant woman, a foetus and, eventually, a newborn with a brain tumour. We report here the main categories of the central nervous system (CNS) foetal tumours: subependymal giant cell astrocytoma (SEGA), teratomas, lipomas, medulloblastomas and germinomas. Foetal brain tumours are mainly sporadic and familial occurrences are rare. We cover prenatal diagnosis – ultrasonography and magnetic resonance imaging (MRI). Foetal brain tumours are relatively readily diagnosed by ultrasonography provided their diameter exceeded 10 mm. However, they may be difficult to detect if “covered” as in cases of unilateral ventriculomegaly or in asymmetric hydrocephalus. The medical procedures, problems of termination of pregnancy in Poland and postnatal prognosis are also described. Eventually, tumours of the CNS in pregnancy are also discussed.
PL
Dostępna literatura na temat nowotworów ośrodkowego układu nerwowego (OUN) u płodów, chociaż niezwykle bogata, składa się głównie z doniesień kazuistycznych, opracowanych zarówno przez położników ultrasonografistów, jak i przez radiologów i neuropatologów. W niniejszej pracy dokonano przeglądu piśmiennictwa, metaanalizy obejmującej 92 przypadki z literatury, ilustrując tekst przykładami z własnego ośrodka referencyjnego – położniczo-pediatrycznego, w którym zapewniona jest kompleksowa opieka zarówno dla ciężarnej, płodu, jak i noworodka z nowotworem OUN. Omówiono podstawowe typy nowotworów wykrywanych w okresie prenatalnym. Są to: podwyściółkowy astrocytoma olbrzymiokomórkowy (SEGA), potworniaki, tłuszczaki, medulloblastoma i nowotwory terminalne. Nowotwory OUN płodu są najczęściej sporadyczne. Rodzinne występowanie anomalii spotyka się wyjątkowo rzadko. Na szczególną uwagę zasługuje diagnostyka prenatalna – ultrasonografia i obrazowanie z użyciem magnetycznego rezonansu jądrowego. Nowotwory OUN stosunkowo łatwo można uwidocznić ultrasonograficznie, gdy ich średnica przekracza 10 mm. Trudne do wykrycia i „przesłonięte” mogą być one w przypadkach jednostronnej wentrykulomegalii lub w asymetrycznym wodogłowiu. W niektórych przypadkach nie tylko nie udaje się ustalić dokładnego rozpoznania nowotworu OUN płodu, ale można rozpoznać ultrasonograficznie jedynie wodogłowie. Dopiero badanie neuropatologiczne okolicy wodociągu mózgu może ujawnić anomalie, np. pod postacią glioneuronalnego hamartomatu. Omówiono także postępowanie w przypadku stwierdzenia nowotworu u płodu, możliwość terminacji ciąży w Polsce oraz losy noworodka po porodzie. W diagnostyce różnicowej należy brać pod uwagę stwardnienie guzowate, krwawienia do ośrodkowego układu nerwowego, hemimegaencephalon, „tętniak” żyły Galena oraz torbiele pajęczynówki. Opisano także problem nowotworu OUN u ciężarnej.
Discipline
Year
Volume
9
Issue
3
Pages
164-182
Physical description
References
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