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June 1968

Glial Tumor Metastases Through a Ventriculo-Pleural Shunt: Resultant Massive Pleural Effusion

Author Affiliations

New York
From the Neurological Clinical Research Center, Neurological Institute, Columbia Presbyterian Medical Center, the departments of neurology and pathology (Division of Neuropathology), College of Physicians and Surgeons, Columbia University, New York. Dr. Moiel is a visiting fellow in neuropathology, College of Physicians and Surgeons, Columbia University.

Arch Neurol. 1968;18(6):649-653. doi:10.1001/archneur.1968.00470360071007

EXTRACRANIAL metastases from central nervous system (CNS) neoplasms are unusual and in the great majority of instances follow surgery at the primary site.1 Zimmerman2 has shown experimentally in mice that if glial tumor cells are given access to the systemic circulation, they implant and grow in lung, liver, and other organs. It has therefore been suggested that surgery facilitates metastasis by opening paths of exit from the CNS not usually available because of the blood-brain barrier, absence of lymphatic drainage, and perhaps raised intracranial pressure.3,4

The present report describes spread of an atypical cerebellar astrocytoma to pleura through a ventriculo-pleural shunt. It is the fifth recorded example of spread through a shunt,4-6 and as a result of the massive effusion which occurred, the first in which the diagnosis was made before death.

Report of a Case  A 19-year-old man was admitted on Sept

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