Pleomorphic xanthoastrocytoma with anaplastic features: A case report.

Pleomorphic xanthoastrocytoma has been considered as an astrocytic tumor with relatively favorable prognosis. It corresponds to WHO Grade-II neoplasm. Recently, several patterns with relatively poor prognosis have been recorded and a new concept of “PXA with anaplastic features” has been proposed. The present case is about a 9-year–old girl who presented with symptoms of recurrent headache, seizures and poor academic performance. MRI revealed left frontoparietal irregular enhancing mass lesion with callosal involvement and right mid-brain arteriovenous malformation. Clinical and radiological examination was suggestive of a high grade glial neoplasm/PNET. A diagnosis of high grade glial neoplasm was rendered on the squash smears submitted for frozen sections based on the presence of spindle cells, admixed with pleomorphic bizarre, giant cells with multilobated nuclei showing few atypical mitosis and abundant eosinophilic cytoplasm. Frontal craniotomy with debulking of the tumor was performed and permanent sections revealed a biphasic glial neoplasm with spindle cells arranged in fascicles admixed with bizarre multinucleated giant cells showing abundant vacuolated and lipidized cytoplasm, nuclear hyperchromasia with intranuclear inclusions. Eosinophilic granular bodies, mitosis of 7/10 HPF, micro vascular proliferation, necrosis and invasion into the underlying brain parenchyma were noted. With these histomorphological fi ndings a diagnosis of pleomorphic xanthoastrocytoma with anaplastic features was rendered.

Clinical Value of MR Spectroscopy in Preoperative Grading of Astrocytic Tumors / 实用放射学杂志

Objective To explore the value of MR spectroscopy in preoperative grading of astrocytic tumors.Methods 52 cases with astrocytomas proved by pathology,including 20 diffuse astrocytomas,14 anaplastic astrocytomas and 18 glioblastomas,underwent MR spectroscopy with multi-voxel PRESS sequence.Results ①Astrocytic tumors were characterized by increased Cho and decreased NAA,while Lipids were present in high-grade astrocytic tumors;②Cho/Cr(r＝0.656,P=0.000),Lip1.3/Cr(r＝0.559,P=0.001) and Glx/Cr(r＝0.482,P=0.005) in the solitary tumor's regions had a significant positive correlation with the grading of astrocytic tumors, while Cho/NAA(r＝0.395,P=0.025),Lip0.9/Cr(r＝0.386,P=0.029) had a positive correlation with the tmor grading;③When Cho/Cr＝2, the sensitivity, specificity,positive predictive value and negative predictive value for diagnosis of WHO4 astrocytic tumors were 94.4%,64.3%,77.3% and 90% respectively;④When Lip1.3/Cr＝0.526, the sensitivity, specificity,positive predictive value and negative predictive value for diagnosis of WHO4 astrocytic tumors were 88.9%,92.9%,94.1% and 86.7% respectively. Conclusion MR spectroscopy is helpful in preoperative grading of astrocytic tumors.

Bcl-2 and Bax Expression and Ki-67 Proliferative Index in Astrocytic Tumors: in Relation to Prognosis

OBJECTIVE: We report a retrospective investigation of the prognostic value of bcl-2 and bax expression, and Ki-67 proliferative index in 42 astrocytic tumors. METHODS: We classified the astrocytic tumors and reviewed the clinical information and survival time. The sections were taken from surgically resected paraffin-embedded tissue and performed immunohistochemical stains for bcl-2, bax and Ki-67. RESULTS: The immunohistochemical stain for bcl-2 revealed a positivity in only two(4.76%) among forty-two cases. The immunostain for bax was positive in 35 cases(83.3%). However, the correlation between bcl-2 & bax expression and age, sex, tumor location, size, and histologic grade was not found. By Kaplan-Meier analysis, bcl-2 & bax expression and survival time in astrocytic tumors was no significance in log rank test(p>0.05). There were prognostic values between Ki-67 LI and histologic grade and between Ki-67 LI and survival time, respectively(p<0.05). CONCLUSION: Bcl-2 and bax are not significant, whereas Ki-67 LI is suggested as a significant prognostic factor, associated with histologic grade and survival time of astrocytic tumors.

Construction of tissue microarray with astrocytic tumor microvessels of human brain / 第三军医大学学报

Objective To construct tissue microarray with astrocytic tumor microvessels(AstMV) of human brain and investigate astrocytic tumor angiogenesis.Methods Thirty-six specimens containing different microvessels from 200 specimens were selected as donor blocks,which was followed by punching,sampling and seeding samples with tissue microarray apparatus.The tissue microarrays were used to detect the expression of CD34,FⅧ-RAg and CD105.Results Tissue microarray of AstMV was successfully constructed and an instrument for location was made.CD34,FⅧ-RAg and CD105 were expressed on endothelial cell membrane or(and) plasma.There were difference in microvessel number between astrocytic tumors and between endothelial markers.In the gradeⅡ,Ⅲ and Ⅳ astrocytomas,microvessels labeled by CD34 and FⅧ-RAg antibodies were more than those detected by CD105 antibody.There were number difference in microvessels labeled by CD34 and FⅧ-RAg antibodies between grade Ⅰ and gradeⅡ,Ⅲ and Ⅳ tumors.Conclusion Construction of tissue microarray containing different tumor microvessels might be of significance in evaluating tumor angiogenesis.This study may be the basis for constructing digital tumor microvessel models and exploring the mathematic relation between astrocytic tumor microvessels and vascular growth factors.

Prognostic Implications of the MIB-1 Labeling Index in Astrocytic Tumors

OBJECTIVE: The proliferative potential of intracranial glioma affects the histological malignancy and prognosis of patients with these tumors. In this study, we present the relationship between MIB-1 labeling index(LI) and clinical variables which might play the major role in determining the prognosis of patient with astrocytic tumors. PATIENTS AND METHODS:Excised tumor specimens from a total of 52 patients were stained to detect monoclonal MIB-1-Ki-67 antibody by avidin-biotin complex immunohistochemistry. The MIB-1 LI was evaluated with histological grades, demograpghic data, and survival time. The statistical significance of their correlation was analyzed by Pearson correlation test. RESULTS: The 52 patients included 30 male patients and 22 female patients. The tumors according to the criteria of the World Health Organization(WHO) classification were verified as pleomorphic xanthoastrocytoma in one, pilocytic astrocytomas 4, astrocytomas 1, anaplastic astrocytomas 3, and glioblastomas 31. MIB-1 LI in astrocytic ttumors showed no correlation with age and gender. However, the patients under 10 years had the longest survival time, whereas short survival time was observed in the older patients. The mean MIB-1 LI of different tumor grades were as follows:pleomorphic xanthoastrocytoma, 4.40+/-0.00;pilocytic astrocytoma, 4.53+/-3.09; astrocytoma, 5.50+/-6.03; anaplastic astrocytoma, 12.68+/-12.50; Glioblastoma, 21.31+/-19.63. Although the levels of MIB-1 LI were varied in individual tumors, the MIB-1 LI was increased in parallel with the histological grades. Glioblstomas showed significantly higher MIB-1 LI compared with that of anaplastic astrocytomas and low grade astrocytomas (p = 0.001). The mean survival time of entire group of patients was also well correlated with MIB-1 LI in astrocytic tumors(p = 0.015). Moreover, the mean survival time of the entire group of patients with Lis or= 10 was 60.71+/-62.58 weeks. This difference was also statistically significant(p = 0.004). CONCLUSION: The results of this study suggest that MIB-1 LI correlates with histological grades and might play a significant role in predicting the survival of patients with astrocytic tumors.

A Study of the Relationship between p53 Mutation and Proliferating Activities in Astrocytic Tumors

To evaluate the relationship between p53 protein expression and proliferating activity in astrocytic tumors, we performed a study using 37 cases of astrocytic tumors; 13 cases of low-grade astrocytoma (LGA), 9 cases of anaplastic astrocytoma (ANA), and 15 cases of glioblastoma multiforme (GM). The p53 protein expression was studied by immunohistochemical staining (IHC) with DO-7 monoclonal antibody in 37 cases and p53 mutation was detected by single strand conformational polymorphism (SSCP) using PCR products of 31 cases. Proliferating activities were detected by Ki-67 (MIB-1) and proliferating cell nuclear antigen (PCNA). Immunohistochemically, 24.3% (9/37) of astrocytic neoplasms showed p53 expression, which consisted of 7.7% (1/13) of LGA, 44.4% (4/9) of ANA, and 26.7% (4/15) of GM. The p53 expression was statistically significant between the tumor grades. p53 mutations on exon 5 were noted in 6 (19.4%) out of 31 cases of astrocytic tumors. Average indices of MIB-1 and PCNA were 1.5 2.6% and 7.0 10.1% in LGA, 10.0 12.7% and 23.7 23.2% in ANA, and 30.9 22.4% and 69.9 26.7% in GM, respectively. p53 positive group by IHC showed significantly higher average MIB-1 (26.2 23.5%) and PCNA index (56.7 30.3%) than those (12.1 18.3%, 27.6 29.6%) of p53 negative group (p<0.05). p53 mutation group also showed significantly higher MIB-1 (30.7 26.0%) and PCNA index (55.5 32.6%) than those without p53 mutation (10.8 16.5%, 24.2 28.7% respectively). These results showed that about one-fifth of astrocytic tumors have p53 abnormalities, which were related with higher proliferating activities than those without p53 abnormalities.

Significance of NF-?B expression in human cerebral tumors / 中国癌症杂志

Purpose:To evaluate the significance of NF ?B P65 protein expression in various human cerebral tumors. Methods:The expression of NF ?B P65 protein in 106 cases of cerebral tumors was studied immunohistochemically. 106 cases included 64 cases of astrocytic tumors and 22 cases of medulloblastoma and 20 cases of meningioma. 10 cases of normal brain tissue were employed as a control group.Results:The positive rate of NF ?B P65 protein of 64 astrocytic tumor specimens was 54.7%; the positive rate of NF ?B P65 protein of 22 cases of medulloblastoma was 36.4% and 5.0% for 20 cases of meningioma. In contrast, none of the normal tissues exhibited NF ?B P65 protein staining. Significant difference were observed between astrocytic tumor group and meningioma, as well as between medulloblastoma and meningioma ( P

The Relationship between Clinical Features and Changes of Proliferative Activity Analysed by Ki-67 in Recurrent Astrocytic Tumors

The relationship between the proliferative activity and clinical features in 21 cases of recurrent astrocytic tumors were studied. The proliferative activity of tumor cell was analysed by Ki-67 labelling index using immunohistochemistry for MIB-1 antibody. Positive relationships were noted on clinical features, such as mean ages, time interval between primary and secondary operation, postoperative survival, and histopathologic grade with Ki-67 labelling indices in the primary tumors. Unlike to these, clinicopathologic characteristrics were not positively correlated in secondary recurrent tumors. It is thus suggested that Ki-67 labelling indices would be valuable in the estimations of clinical prognosis and histopathologic grades in the primary astrocytic tumors but might not be in the recurrent astrocytic tumors due to change of biologic features of tumor cell after radiotherapy and/or chemotherapy.