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Differentiation in the medulloblastoma

A histological and immunohistochemical study

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Summary

The histological and immunohistological features of medulloblastomas were investigated in patients participating in an ongoing cooperative study of the Societé International d'Oncologie Pédiatrique (SIOP). Of 51 neoplasms, four were the classic desmoplastic variant. In regard to the histological features used to grade neoplasms, considerable inter- and intratumoral variation was observed. The neoplasms with the most pleomorphic and coarsely structured nuclei tended to be neuroblastic, whereas the most delicate and uniform nuclei were found in the desmoplastic neoplasms. Twenty-one of the cases exhibited neuroblastic differentiation in the form of neuroblastic rosettes. Of these, three also contained neoplastic ganglion cells. Of the five medulloblastomas that were calcified, four contained neuroblastic rosettes in accord with the tendency for calcification in neuroblastic neoplasms. In many of the neuroblastic neoplasms, islands of markedly neuronspecific enolase (NSE)-positive cells were seen. Although the limited specificity of this marker enzyme is recognized, we believe that this focal intense staining could indicate neuronal differentiation somewhat more advanced than in small NSE-positive islands of reduced cellularity, many of which were strongly positive. The nuclei in these island were usually larger and more vesicular than those in the surrounding densely cellular areas. These features and the frequent association with Homer-Wright rosettes suggest that these foci represent a form of neuronal differentiation. Astrocytic differentiation was more difficult to define and required the use of staining for glial fibrillary acidic protein (GFAP). Six neoplasms contained GFAP-positive cells that were clearly neoplastic. Many others contained scattered reactive astrocytes and dispersed cells whose neoplastic versus reactive nature could not be defined. Foci with an oligodendroglial appearance were seen in nine cases, but the association with neuroblastic features elsewhere in most of these raises the issue as to the oligodendroglial nature of these foci. Neoplasms with ependymal differentiation were not seen. The results confirm that the medulloblastoma is heterogeneous in regard to tissue pattern and features of histological ‘malignancy’. In regard to differentiation, that along neuronal lines is predominant, readily recognized in standard histological sections, frequently obvious throughout the lesion, and occasionally associated with maturation to mature ganglion cells. Astrocytic differentiation, on the other hand, requires immunohistochemistry, is often difficult to distinguish from reactive gliosis, and, in the limited number of cases seen, did not demonstrate a spectrum of maturation to well-differentiated astrocytes.

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References

  • Becker LE, Hinton D (1983) Primitive neuroectodermal tumors of the central nervous system. Human Pathol 14:538–550

    Google Scholar 

  • Bellani FF, Gasparini M, Lombardi F, Zucali R, Luccarelli G, Migliavacca F, Moise S, Nicola G (1984) Medulloblastoma-results of a special sequential combined treatment. Cancer 54:1956–1961

    Google Scholar 

  • Bloom HJG, Wallace ENK, Henk JM (1969) The therapy and prognosis of medulloblastoma in children. Am J Roentgenol 105:43–62

    Google Scholar 

  • Burger PC (1985) The ideal classification of pediatric central nervous system tumors. Cancer 56:123–126

    Google Scholar 

  • Camins MB, Cravioto HM, Epstein F, Ransdorff J (1980) Medulloblastoma: an ultrastructural study — evidence for astrocytic and neuronal differentiation. Neurosurgery 6:398–411

    Google Scholar 

  • Caputi AJ, McCullough DC, Manz HJ, Patterson K, Hammock MK (1987) A review of the factors influencing the prognosis of medullobastoma. The importance of cell differentiation. J Neurosurg 66:80–87

    Google Scholar 

  • Chatty EM, Earle KM (1971) Medulloblastoma. A report of 201 cases with emphasis on the relationship of histologic variants to survival. Cancer 28:977–983

    Google Scholar 

  • Chin HW, Maruyama Y (1982) Prognostic factors in medulloblastoma. Am J Oncol 5:359–369

    Google Scholar 

  • Coffin CM, Mukai K, Dehner LP (1983) Glial differentiation in medulloblastomas. Am J Surg Pathol 7:555–565

    Google Scholar 

  • Foerster O, Gagel O (1939) Das umschriebene Arachnoidalsarkom des Kleinhirns. Z Gesamte Neurol Psychiat 164: 565–580

    Google Scholar 

  • Friedman HS, Burger PC, Bigner SH, Trojanowski JQ, Halperin EC, Bigner DD (1985) Establishment and characterization of the human medulloblastoma tumor cell line D283 MED. J Neuropathol Exp Neurol 44:592–605

    Google Scholar 

  • Giordana MT, Mauro A, Migheli A, Schiffer D (1983) Contributions of immunohistochemistry to the problem of differentiation in medulloblastoma. Ital J Neurol Sci 4:411–415

    Google Scholar 

  • Haimoto H, Takahasi Y, Koshikawa T, Nagura H, Kato K (1985) Immunohistochemical localization of gammaenolase in normal human tissues other than nervous and neuroendocrine tissues. Lab Invest 52:257–263

    Google Scholar 

  • Harisiadis L, Chang CH (1977) Medulloblastoma in children: a correlation between staging and results of treatment. Int J Radiat Oncol Biol Phys 2:833–841

    Google Scholar 

  • Hassoun J, Gambarelli D, Grisoli F, Pellet W, Salamon G, Pellissier JF, Toga M (1982) Central Neurocytoma. An electron-microscopic study of two cases. Acta Neuropathol (Berl) 56:151–156

    Google Scholar 

  • Herpes MJHM, Budka H (1985) Primitive neuroectodermal tumors including the medulloblastoma: glial differentation signaled by immunoreactivity for GFAP is restricted to the pure desmoplastic medulloblastoma (“arachnoidal sarcoma of the cerebellum”). Clin Neuropathol 4:12–18

    Google Scholar 

  • Kane W, Aronson SM (1967) Gangliogliomatous maturation in cerebellar medulloblastoma. Acta Neuropathol (Berl) 9: 273–279

    Google Scholar 

  • Kawano N, Yaka K, Aihara M, Yagashita S (1983) Oligodendroglioma-like cells (clear cells) in ependymoma. Acta Neuropathol (Berl) 62:141–144

    Google Scholar 

  • Kopelson G, Linggood RM, Kleinman GM (1983) Medulloblastoma — the identification of prognostic subgroups and implications for multimodality management. Cancer 51:312–319

    Google Scholar 

  • Mannoji H, Takeshita I, Fukui M, Ohta M, Kitamura K (1981) Glial fibrillary acidic protein in medulloblastoma. Acta Neuropathol (Berl) 55:63–69

    Google Scholar 

  • Packer RJ, Sutton LN, Rorke LB, Littman PA, Sposto R, Rosenstock JG, Bruce DA, Schut L (1984) Prognostic importance of cellular differentiation in medulloblastoma of childhood. J Neurosurg 61:269–301

    Google Scholar 

  • Packer RJ, Tremblay JF, Rorke LB, Trojanowski JQ, Sutton LN, Bruce DB, Schut L (1985) Prognostic importance of expression of cytoskeletal proteins in childhood primitive neuroectodermal tumors (medulloblastoma). Ann Neurol 18:140

    Google Scholar 

  • Palmer JQ, Kasselberg AG, Netsky MG (1981) Differentiation of medulloblastoma — studies including immunohistochemical localization of glial fibrillary acidic protein. J Neurosurg 55:161–169

    Google Scholar 

  • Pearl GS, Takei Y (1981) Cerebellar “neuroblastoma”: nosology as it relates to medulloblastoma. Cancer 47:772–779

    Google Scholar 

  • Roessmann U, Velasco ME, Gambetti P, Autilio-Gambetti L (1983) Neuronal and astrocytic differentiation in human neuroepithelial neoplasms — an immunohistochemical study. J Neuropathol Exp Neurol 42:113–121

    Google Scholar 

  • Rorke LB (1983) The cerebellar medulloblastoma and its relationship to primitive neuroectodermal tumors. J Neuropathol Exp Neurol 42:1–15

    Google Scholar 

  • Rubinstein LJ, Northfield DWC (1964) The medulloblastoma and the so-called “arachnoidal cerebellar sarcoma”. A critical re-examination of a nosological problem. Brain 87: 379–412

    Google Scholar 

  • Sternberger LA, Hardy PH Jr, Culculis JJ, Meyer HG (1970) The unlabeled antibody-enzyme method of immunohistochemistry. Preparation and properties of soluble antigen-antibody complex (horseradish peroxidase-antiperoxidase) and its use in the identification of spirochetes. J Histochem Cytochem 18:315–333

    Google Scholar 

  • Torres LF, Grant N, Harding BN, Scaravelli F (1985) Neuronspecific enolase and neurofilament protein as markers of differentiation in medulloblastoma. Surg Neurol 23:177–182

    Google Scholar 

  • Velasco ME, Ghorbrial MW, Ross ER (1985) Neuron-specific enolase and neurofilament protein as markers of differentiation in medulloblastoma. Surg Neurol 23:177–182

    Google Scholar 

  • Vinores SA, Rubinstein LJ (1985) Simultaneous expression of GFAP and NSE by the same reactive or neoplastic astrocytes. Neuropathol Appl Neurobiol 11:349–359

    Google Scholar 

  • Vinores SA, Bonnin JM, Rubinstein LJ, Marangos PJ (1984) Immunohistochemical demonstration of neuron-specific enolase in neoplasms of the CNS and other tissues. Arch Pathol Lab Med 108:536–540

    Google Scholar 

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Burger, P.C., Grahmann, F.C., Bliestle, A. et al. Differentiation in the medulloblastoma. Acta Neuropathol 73, 115–123 (1987). https://doi.org/10.1007/BF00693776

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