Ganglion cells in circumscribed astrocytic tumors: possible implication in classification and prognosis / Implicação da presença de células ganglionares na classificação e evolução de tumores astrocíticos circunscritos

INTRODUCTION: Glial and neuroglial cell neoplasms comprise pilocytic astrocytoma (PA), pleomorphic xanthoastrocytoma (PXA) and ganglioglioma (GG), which share various similarities, though PA has better prognosis. As ganglion cells (GC) may be scarce in GG and these gangliogliomas may recur or progress to grade III, an accurate diagnosis is essential. OBJECTIVES: The aim was to identify GC and eosinophilic granular bodies (EGB) in PA and PXA, to evaluate its effect on patient’s outcome and compare them with GG. METHODS: A retrospective analysis of radiological, morphological and follow-up aspects (disease free-survival, recurrence and death) of 30 cases (14 PA, 8 PXA, 8 GG). Hematoxylin and eosin (HE) stained sections were reviewed to identify the presence of neoplastic GC and EGB. They were immunostained for synaptophysin (SYN) and neurofilament (NF). Glial fibrillary acidic protein (GFAP) immunostaining was performed in selected cases. RESULTS: Six PA were reclassified as GG due to the presence of GC by HE or immunohistochemistry. Some EGB resembling degenerate GC were also immunostained for SYN/NF and most of them were negative for GFAP. The mean disease-free survival was 62.16 months. Four tumors recurred and one patient died. All PXA had GC, suggesting that they were variants of GG, 4 of which recurred and one patient died. Mean disease-free survival was 69 months. The radiological aspect was predominantly cystic. CONCLUSION: We propose that PA and PXA with GC or with EGB immunopositive for neuronal markers could be variants of GG, and some EGB may represent degenerate GC. However, the presence of GC does not seem to modify the biological behavior of these neoplasms.

INTRODUÇÃO: As neoplasias circunscritas incluem astrocitoma pilocítico (AP), xantoastrocitoma pleomórfico (XP) e ganglioglioma (GG), que compartilham diversas semelhanças, sendo o AP o de melhor prognóstico. Como as células ganglionares (CG) no GG podem ser escassas e os GGs podem recidivar ou evoluir (grau III), é fundamental o diagnóstico preciso. OBJETIVOS: Identificar CG e corpos granulares eosinofílicos (CGE) em AP e XP, avaliar sua implicação na evolução e comparar com o GG. MÉTODOS: Análise retrospectiva dos aspectos radiológicos, morfológicos e evolutivos (tempo livre de doença, recidiva e óbito) de 30 casos (14 AP, oito XP, oito GG). Cortes corados com hematoxilina e eosina (HE) foram revistos para a identificação da presença de CG neoplásicas e CGE. Estes foram imunomarcados para sinaptofisina (SIN) e neurofilamento (NF) e, em casos selecionados, para glial fibrillary acidic protein (GFAP). RESULTADOS: Seis AP foram reclassificados para GG pela presença de CG (HE ou imunomarcação). Alguns CGE, semelhantes às CG degeneradas, também imunomarcaram para SIN/NF, a maioria sendo negativa para GFAP. O tempo médio livre de doença foi de 62,16 meses. Quatro tumores recidivaram; um deles evoluiu para óbito. Todos os XP possuíam CG, sugerindo que são variantes de GG, dos quais quatro recidivaram (um óbito). O tempo médio livre de doença foi de 69 meses. O aspecto radiológico foi predominantemente cístico. CONCLUSÃO: Sugerimos que AP e XP com CG ou CGE imunopositivos para marcadores neuronais possam ser variantes de GG e alguns CGE representem CG degeneradas; entretanto, a presença de CG ganglionares parece não modificar o comportamento biológico dessas neoplasias.

Xantoastrocitoma pleomórfico na infância: relato de dois casos / Pleomorphic xanthoastrocytoma: report of two cases

O xantoastrocitoma pleomórfico é uma neoplasia rara,classificada como grau II ou III pela Organização Mundial da Saúde,a depender do aspecto histopatológico.Descrevemos dois casos de portadores de xantoastrocitoma pleomórfico,cujo tratamento escolhido foi o cirúrgico.A associação com quimioterapia foi realizada em um dos pacientes.Haja vista a baixa freqüência desse tipo de neoplasia,torna-se fundamental a realização de novos estudos para o desenvolvimento de protocolos de tratamento que vislumbrem a diminuição da taxa de recidivas.

Espectroscopia multivoxel com tempo de eco curto: a razão colina/N-acetil-aspartato e a graduação dos astrocitomas cerebrais / Multivoxel spectroscopy with short echo time: choline/N-acetyl-aspartate ratio and the grading of cerebral astrocytomas

Avaliou-se a relação colina/N-acetil-aspartato (Co/NAA), obtida pela espectroscopia multivoxel com tempo de eco (TE) curto, na graduação histológica dos astrocitomas encefálicos (graus I, II e III-IV), comparando com o parênquima cerebral normal. Observou-se aumento significativo (p<0,05) das relações médias de Co/NAA nos três grupos de astrocitomas estudados em relação ao tecido normal, havendo tendência de elevação com o aumento da graduação, sem significância estatística, que correspondeu a: 0,53±0,24 no grupo controle, 1,19±0,49 no grau I, 1,58±0,65 no grau II e 5,13±8,12 no grupo de alto grau (graus III-IV). Houve aumento da relação Co/NAA em 4/5 (80 por cento) dos pacientes com grau I, 5/6 (83 por cento) com grau II e 10/20 (50 por cento) com graus III e IV. Concluiu-se que a espectroscopia multivoxel com TE curto pode ser usada na discriminação entre o parênquima normal e o tecido neoplásico. Entretanto, nem todo tecido neoplásico estudado apresentou aumento da relação Co/NAA, principalmente o grupo com maior malignidade.

The choline/N-acetyl-aspartate (Cho/NAA) ratio, obtained by the multivoxel spectroscopy with short echo time (TE), was evaluated, in the histological grading of the brain astrocytomas (grades I, II and III-IV) in comparison with the normal cerebral parenchyma. A significant increase (p<0.05) in the average ratios of Cho/NAA was observed in the three astrocytoma groups studied in relation to normal tissue, having a tendency to increase with the increase in grading, without any statistic significance, which corresponded to: 0.53±0.24 in the control group, 1.19±0.49 in grade I, 1.58±0.65 in grade II and 5.13±8.12 in the high grade group (grades III-IV), with variation in the values encountered. There was an increase in the Cho/NAA ratio in 4/5 (80 percent) in grade I, 5/6 (83 percent) in grade II and 10/20 (50 percent) in grades III and IV. We conclude that multivoxel spectroscopy with short TE can be used in discriminating between normal parenchyma and neoplasm tissue. However, not all neoplasm tissue studied presented an increase in Cho/NAA, especially in the group with higher grade of malignancy.

Immunohistochemical evaluation of P53 exprssion in astrocytomas

Alteration of the P53 tumor suppressor gene is implicated in tumorigenesis and in progression of a wide variety of human cancers, including gliomas. Accumulation of P53 protein is used as indicator of alteration in P53 gene. Less is known about P53 expression in reactive non-neoplastic lesions [gliosis]. This work is done to verify, the presence of P53 in astrocytomas through immunohistochemistry as well as correlating its expression with clinicopathological parameters and to detect its role in differentiating gliosis from low grade astrocytomas. Ninety-one astrocyromas and 24 cases of reactive gliosis were retrospectively collected from Pathology Department in Assiut University Hospital and private laboratories. Astrocytomas were classified and graded according to WHO classification [2000] using H and E stained sections from formalin fixed paraffin embedded blocks. P53 was immunohistochemically evaluated in selected 46 cases of astrocytomas and 12 cases of reactive gliosis. Glioblastoma multiforme [WHO grade IV] was the predominant grade of astrocytomas. The mean age of patients with asirocytomas showed upregulation with grade. There was male sex predilection in all grades of astrocytomas. P53 protein was detected in 58.7% of astrocytomas including all grades. The immunoreactivity score showed gradual upregulation with increasing grade. There was positive insignificant correlation between P53 expression and age, cellularity and mitosis and positive significant correlation between its expression and pleomorphism, microvascular proliferation and necrosis. All cases of ghosts except one showed negative P53 immunoreactivity. In P53 protein alteration is an early event in lumarigenesis and progression of astrocytomas and is a useful diagnostic tool in diagnosis of high grade gliomas. P53 provides just one more procedure in differentiation of glios is from low grade astrocyromas

Statistical analysis of astrocytic glioma

Fifty patients of both sexes of Astrocytic Glioma from Sheikh Zayed Hospital and Lahore General Hospital Lahore were included in this study. Ten normal brain tissues [control] were taken from accident cases. Out of 50 study cases there were 16 [32%] were low grade [I-II] Astrocytic Glioma and 34 [68%] were high grade Astrocytic Glioma. The male to female percentage was found out to be 26 [52%] and 24 [48%] respectively. Among the males, 11 [22%] were in grade I-II while 15 [30%] were in grade III-IV Astrocytic Glioma, while 5 [10%] females were in grade I-II and 19 [38%] were in grade No statistical sex difference was seen in the ratio of male and female who developed Astrocytic Glioma [P>0.05]. The ages of the patients ranged from 10 to 76 years with maximum number of cases in the age group 30-49 years. In this age group, 11 [22%] patients had grade I-II while 20 [40%] were in grade type of Astrocytic Glioma. The statistical difference of age in different groups was found to be highly significant, [P<0.01]. The most common presenting complaints were headache, vomiting, weakness of limbs, loss of orientation and giddiness. These were observed mainly in grade III-IV Astrocytic tumors. The complaints of difficulty in speech, papilloedema and fits were observed often with an almost equal ratio in all grades of Astrocytic Glioma. The loss of consciousness was observed only in Grade III-IV tumors. The most common site of Atstorcytic Glioma was Parietal lobe and Fronto-parietal lobe constituting 9 [18%] in grade I-II and 15 [30%] in grade HI-IV Astrocytic Gliomas, that is statistically significant, [P<0.05]. The most common site of Astrocytic Glioma was Parietal lobe, 17 out of 50 [7 in grade I-II and 10 in grade III-IV], while the second most common site of this tumor was Temproparietal region, [4 in grade I-II and 6 in grade III-IV]. There were 29 Astrocytic Gliomas in right lobe [10 in grade I-II, and 19 in grade III-IV], while 18 in left lobe [5 in grade I-II and 13 in grade III-IV]. This was statistically highly significant, [P<0.01]. High grade Astrocytic Glioma was also present in Thalamus, mid brain, and Interventricular septum