Noshuyo byori = Brain tumor pathology最新文献

We previously have reported that indium-111 labeled anti-glioma monoclonal antibody G-22 (111In-G-22) exhibits diagnostic potential against human glioma xenografts in athymic mice. Herein, we report the selective tumor localization of 111In-G-22 in patients with glioma. Five patients were administered an average of 2.2 mCi of 111In-G-22 whole IgG intravenously. No immediate or delayed side effects were attributable to 111In-G-22 injection. Serial gamma scintigraphy and single photon emission computed tomography (SPECT) were performed, and the distribution in the brain and intratumoral accumulation of 111In-G-22 were evaluated. CT and/or magnetic resonance (MR) images were performed simultaneously and these images were compared. In the case of malignant glioma, tumor-imaging was successfully obtained beginning at 6 h following injection with a maximum uptake tumor/brain ratio at 48 h. The distribution of 111In was selective. It predominantly accumulated in the biologically active areas of the tumor. Furthermore, the tracer uptake appeared to correlate with the histologic tumor grade. This confirms the G-22 monoclonal antibody specifically binds to biologically active and malignant glioma tissue, and tumor-imaging using 111In-G-22 may give support to the diagnosis of malignant glioma.

We report two cases of rare histological types of intracranial clear cell tumor. Case 1: The tumor, on the left frontal convexity in a 64-year-old woman, consisted largely of polygonal cells with clear cytoplasm which were divided into lobules of uneven size by abundant fibrous connective tissue. Most of the tumor cells were immunopositive for epithelial membrane antigen and vimentin. Ultrastructurally, the tumor cells showed conspicuous interdigitations of their plasma membranes with frequent junctional complexes, and contained numerous glycogen granules in the cytoplasm and its processes. Occasionally, amianthoid collagen fibers were found in the fibrous stroma. Our diagnosis of this tumor was clear cell meningioma. Case 2: The tumor, in the right cerebellar hemisphere in a 64-year-old woman, consisted of round, clear cells with a honeycomb-like pattern. The tumor cells were positive for glial fibrillary acidic protein, vimentin and S-100 protein. Ultrastructurally, the tumor was composed of round cells arranged in a cell-to-cell pattern, and the adjacent cells often formed microrosettes containing microvilli in their lumina. There were scattered cells with accumulatios of glycogen granules in their cytoplasm. Our diagnosis of this tumor was clear cell ependymoma. From the light microscopic features of these tumors, it does not necessarily seem easy to discriminate them from other intracranial tumors composed of similar clear cells, such as oligodendroglioma, central neurocytoma, hemangioblastoma and metastic renal cell carcinoma. Ultrastructural examination is crucial in the identification of the clear cell variants of meningioma and ependymoma.

A case of medullomyoblastoma is described. Partial removal of a cerebellar tumor was performed at the age of 21 months old, and histopathological diagnosis was medulloblastoma. Death occurred at 15 years of age, due to pneumonia and relapse of the tumor. Autopsy revealed well-differentiated muscular and ependymal components disseminated in the medulloblastic area. Immunohistochemically, desmin was positively detected in not only autopsy materials but also undifferentiated cells of the surgical specimens, suggesting prospective myoblastic differentiation.

Six cases of subependymal giant cell astrocytoma (SGCA), five associated with tuberous sclerosis (TS), were reviewed by light microscopy, electron microscopy and immunohistochemistry. Histologically, all cases showed features typical of SGCA. GFAP and neurofilament expression were found in all cases. Synaptophysin and myelin basic protein were positive in single different cases. The MIB-1 positive rate was 0% in 4 cases, 3% in a case with recurrence after a partial resection, and 6.4% in another case with a rapid growing tumor. By electron microscope, glial filament was identified in the tumor cells of all cases, whereas none of them showed any ultrastructural evidence of a neuronal origin. We therefore suggest that SGCA is a glial origin tumor, arising from the astrocytic part of a subependymal nodule--the most common cerebral lesion of tuberous sclerosis caused by distorted migration of the germinal mantle-the neuronal part of which remains as entrapped remnants of dysgenetic, incompletely expressed neuronal cells.

Expression of proliferating cell nuclear antigen (PCNA) and numbers of nucleolar organizer regions (NORs) were studied by immunohistochemistry and the silver staining technique in 99 meningiomas and related to histopathologic grading, recurrence and their predictive value for recurrence. The results indicated that there was a significant correlation between PCNA or AgNORs and histopathologic grading of meningiomas. Slightly higher expression of PCNA in atypical meningiomas was correlated with the increased recurrence rate; however, expression of PCNA and numbers of AgNORs in meningiomas are not reliable criteria to predict tumor recurrence.

We studied two cases of ganglioglioma immunohistochemically by MIB-1 and p53 staining. The positive rate of MIB-1 in the ganglionic cells was 5.5% in Case 1 and 7.8% in Case 2, and that of MIB-1 in the gliomatous cells was 1.4 and 6.6% respectively. The labeling index of p53 in the ganglionic cells was 7.3% in Case 1 and 7.7% in Case 2, and that of the gliomatous cells was 1.9 and 3.4% respectively. MIB-1 and p53 did not stain ganglionic precursor cells. These results indicate that the ganglionic cells also take part in proliferation and have potential of malignant transformation.

This retrospective immunohistochemical study compares the expression of five stress-response (heat-shock) proteins (srp's) [srp 90, srp 72, srp 27, alpha B-crystallin and ubiquitin], p53 protein and proliferating cell nuclear antigen (PCNA) in 118 primary brain tumors and 21 carcinoma metastases to the central nervous system. Serial sections of formalin-fixed, paraffin-embedded tissues were used. Most astrocytomas (9/13), ependymomas (5/5), glioblastoma multiforme (GBM) (11/12), schwannomas (19/21), meningiomas (22/23) and breast carcinoma metastases (Br-Mt) (9/10), and some medulloblastomas (5/15), primitive neuroectodermal tumors (PNETs) (5/11), pituitary adenomas (4/7) and lung carcinoma metastases (6/11), but none of 10 oligodendrogliomas had tumor cells that expressed one or more (up to five) srp's. The percentage of tumors with p53-positive cells was variable; the proportion was highest among srp-expressing GBMs (mean: 16.1%) and Br-Mts (mean: 15.3%). The mean PCNA-labeling index (LI) also varied, ranging from 1.2% in the group of pituitary adenomas to 24.5% in Br-Mts, with GBMs (20.4%) and medulloblastomas (18.4%) approaching the latter value. PCNA-LI was higher in the astrocytomas, GBMs, medulloblastomas and PNETs that expressed srp's than in those did not. A high proportion of p53-positive cells (31.3 to 59.0%) and the highest PCNA-LIs (41.0 to 49.0%) were seen in two GBMs and one Br-Mt that expressed all five srp's. We conclude that primary and metastatic tumors of the brain produce one or more stress-related proteins, and that a variable proportion of the tumor cells have immunohistochemically-detectable p53, the expression of which may depend, at least in part, on the growth potential of a given tumor.

In order to estimate the degree of malignancy of astrocytomas, we applied image analysis to study the nuclear DNA content and morphometric parameters of individual tumor cells in surgically resected specimens of 20 patients. There were nine low grade astrocytomas (LGA) and 11 high grade astrocytomas (HGA). Although the mean DNA index did not indicate a significant difference between LGA and HGA, five (45%) of the 11 HGA had an aneuploid DNA distribution pattern. By contrast, all LGA had a diploid pattern. The ratio of the S-G2M phase (% S-G2M) of the HGA (17.5 +/- 12.3%) was significantly higher than that of the LGA (7.0 +/- 4.6%). From the morphometric analysis of the area and shape of the nucleus of tumor cells, we obtained quantitative estimates of the degree of nuclear pleomorphism in astrocytomas. The nuclei of the tumor cells of HGA had larger sizes, increased anisokaryosis and were more irregular. In contrast to flow cytometry, image analysis can be used for quantitative studies of morphological tumor cell characteristics of relevance in the grading of malignancy.

Nine cases of symptomatic Rathke's cleft cyst are reported. Their most frequent signs and symptoms included headache, chiasmal syndrome and hypopituitarism, while one of the cases developed a sudden onset of headache and vomiting following diabetes insipidus. Endocrinological findings showed a decreased ACTH, gonadotropin and growth hormone more frequently while there were 2 cases of hyperprolactinemia and 1 case of diabetes insipidus. In a neuroradiological examination, a plain skull X-ray showed 5 cases of ballooning of the sella turcica, and a CT scan demonstrated a low to high density of the cyst and 2 cases of marginal enhancement of the cyst. MRI mostly demonstrated a well delineated mass at the sella extending mostly into the suprasellar region and a low to high intensity of the cyst in the T1-weighted image. Two cases were marginally enhanced after gadolinium DTPA administration. The pathological examination, done on 6 cases, showed either single or multiple layers of the epithelium which were mostly ciliated. The epithelium was positive in PAS and Alcian blue in all cases and a histochemical examination showed 3 cases to be positive in EMA and 2 cases positive in CEA. A resection of the cyst wall and an opening of the cyst is thus recommended in symptomatic cases. Therefore, the transsphenoidal approach should be the choice of treatment in an intra- and suprasellar extension of the cysts with sellar enlargement.(ABSTRACT TRUNCATED AT 250 WORDS)

Changes of bromodeoxyuridine labeling index at recurrence were examined in 6 glioblastomas, 2 anaplastic astrocytomas, and 3 fibrillary astrocytomas. Decreased labeling index occurred in 5 glioblastomas, probably due to the effects of combined radiotherapy and chemotherapy, but was not correlated with a favorable outcome. No change of labeling index occurred in 1 anaplastic astrocytoma. Increased labeling index was seen in 1 glioblastoma, 1 anaplastic astrocytoma, and 3 fibrillary astrocytomas, possibly indicating rapid progression just before surgery for recurrent tumor. Recurrent astrocytomas had become anaplastic astrocytoma or glioblastoma, but demonstrated no specific histopathology or labeling index of the primary lesion.