"Peripheral ring enhancement" of intracranial lesions in the CT examination is still being considered as a specific manifestation for abscess or a cyst tumor. The author analysed 33 cases with peripheral ring enhancement and concluded that although most of brain abscesses, metastatic brain tumors and cystic astrocytomas might demonstrate it, it was not specific for any diseases. To reach the correct diagnosis, it is necessary to collect and analyse the clinical features, laboratory data, and follow-up CT in addition to present CT findings. Examples of the various types of lesions that demonstrate peripheral ring enhancement are shown. It is suggested that various pathology could demonstrate "ring enhancement lesion", if CT scan were done at a fortuitous time. Some differential diagnostic suggestions are also made.
Abscess ; Astrocytoma ; Brain Abscess ; Brain Neoplasms ; Diagnosis ; Follow-Up Studies ; Pathology ; Tomography, X-Ray Computed*

Astrocytoma ; diagnosis ; genetics ; pathology ; surgery ; Gene Expression Regulation, Neoplastic ; Humans ; Prognosis

BACKGROUND: Mixed gliomas, such as oligoastrocytomas (OA), anaplastic oligoastrocytomas, and glioblastomas (GBMs) with an oligodendroglial component (GBMO) are defined as tumors composed of a mixture of two distinct neoplastic cell types, astrocytic and oligodendroglial. Recently, mutations ATRX and TP53, and codeletion of 1p/19q are shown to be genetic hallmarks of astrocytic and oligodendroglial tumors, respectively. Subsequent molecular analyses of mixed gliomas preferred the reclassification to either oligodendroglioma or astrocytoma. This study was designed to apply genetically integrated diagnostic criteria to mixed gliomas and determine usefulness and prognostic value of new classification in Korean patients. METHODS: Fifty-eight cases of mixed OAs and GBMOs were retrieved from the pathology archives of Seoul National University Hospital from 2004 to 2015. Reclassification was performed according to genetic and immunohistochemical properties. Clinicopathological characteristics of each subgroup were evaluated. Overall survival was assessed and compared between subgroups. RESULTS: We could reclassify all mixed OAs and GBMOs into either astrocytic or oligodendroglial tumors. Notably, 29 GBMOs could be reclassified into 11 cases of GBM, IDH-mutant, 16 cases of GBM, IDH-wildtype, and two cases of anaplastic oligodendroglioma, IDH mutant. Overall survival was significantly different among these new groups (p<.001). Overall survival and progression-free survival were statistically better in gliomas with IDH mutation, ATRX mutation, no microscopic necrosis, and young patient age (cut off, 45 years old). CONCLUSIONS: Our results strongly suggest that a genetically integrated diagnosis of glioma better reflects prognosis than former morphology-based methods.
Astrocytoma ; Classification ; Diagnosis ; Disease-Free Survival ; Genetics ; Glioblastoma ; Glioma ; Humans ; Necrosis ; Oligodendroglioma ; Pathology ; Prognosis ; Seoul

A retrospective study of 29 cases of brain-stem gliomas(BSG's) from 1989 to 1993, was performed to determine prognostic factors. Our study also analyzed clinical features, growth patterns, pathologic findings and modalities of treatment in patients with brain-stem gliomas. The patients ranged in age from 6 to 65 years, most commonly in the first decade. The symptom duration prior to diagnosis was 1/2 to 6 months(mean 1 1/2 months). The most common symptom and sign were cranial nerve palsies, especially 6th or 7th cranial nerve. The growth patterns of BSG's were classified into diffuse tumors(7 patients), exophytic(9 patients), focal(2 patients) and cervicomedullary(1 patient). Twenty three of 29 patients were diagnosed pathologically by means of stereotactic biopsy(13 patients) and ope surgery(10 patients). The Pathologic findings were low grade astrocytoma in 9 patients, oligodendroglioma(3 patients), malignant astrocytoma(7 patients), and glioblastoma mulitiforme(4 patients). A significant correlation between diffuse growth pattern and malignant pathologic finding could be obtained(P=0.05). The methods of radiation therapy for BSG's were conventional(10 patients), hyperfractionated(13 patients), and Gamma knife radiosurgery(6 patients). The median survival time was 12 months. The Poor prognostic factors determined in our study were 1) short symptom duration prior to diagnosis(< or = 2 months), 2) diffuse growth pattern, 3) malignant pathologic finding, 4) tumor without cystic portion, and 5) tumor without hydrocephalus.
Astrocytoma ; Cranial Nerve Diseases ; Cranial Nerves ; Diagnosis ; Glioblastoma ; Glioma ; Humans ; Hydrocephalus ; Magnetic Resonance Imaging ; Pathology* ; Prognosis* ; Retrospective Studies

Gliofibroma is a rare astrocytic tumor, composed of a glial component ranging from benign to high grade of malignancy and a consistently benign mesenchymal component. Its exact biological behavior is not fully known. In addition, histogenesis and prognostic factors are also still debatable. We herein present a rare case of gliofibroma in a 25-yr-old male with seizure. A computed tomographic scan of the brain showed a 1.5 cm-sized, enhancing mass with calcification. Histologically, the tumor consisted of glial fibrillary acidic protein (GFAP)-positive glial cells admixed with a mesenchymal component and extensive collagen lay down. The glial cells displayed variable cellularity, but without mitosis or necrosis. Since the MIB-1 labeling index was up to 35.8% in the cellular areas of the glial component, it could be considered to be a predictor of worse prognosis.
Adult ; Astrocytoma/*diagnosis/pathology ; Brain Neoplasms/*diagnosis/pathology ; Glial Fibrillary Acidic Protein/biosynthesis ; Human ; Immunohistochemistry ; Male ; Mitosis ; Necrosis ; Prognosis ; Seizures/complications ; Tomography, X-Ray Computed

Bone metastasis from a spinal cord astrocytoma has been reported only twice in the English medical literature. It is generally known that bone metastasis is found after the initial diagnosis with/without intervening surgery rather than being found at the time of the diagnosis of astrocytoma. The purpose of this article is to report for the first time a case of concurrent bone metastasis from a spinal cord astrocytoma at the time of diagnosing the spinal cord astrocytoma.
Astrocytoma/diagnosis/*secondary ; Humans ; *Lumbar Vertebrae ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Spinal Cord Neoplasms/diagnosis/*pathology ; Spinal Neoplasms/diagnosis/*secondary ; *Thoracic Vertebrae

The posterior fossa, which contains about one fourth of the intracranial contents, is the site of known about two thirds of pediatric intracranial tumors. In about such tumors are less common and the prognosis may bevery poor. However, it is important to recognize the earliest symptoms because of the relatively high ease rate of operable management and the possibility for a high cure rate in some cases. A series of 51 pathologically verified posterior fossa tumors seen at the Department of Neurosurgery, Yonsei University, Severance Hospital over several years were studied. These tumors were explored surgically, and the diagnosis being made through histological examination. The cases were reviewed as to history, development and progression of the neurological features, laboratory findings, roentgenograms, differential diagnosis, operative methods and findings, and pathology. The authors emphasized some interesting points which are illustrated as follows; 1. Among 51 cases of posterior fossa tumors, 25 cases of acoustic neuroma, 9 cases of astrocytoma, 9 cases of medulloblastoma, 2 cases of ependymoma, 3 cases of pontine glioma and 3 cases of cysticercosis in the fourth ventricle were found, comprising 21 males and 30 females. 2. The 25 operated cases of acoustic neuroma were between the age of 20 and 60. Eighteen cases(69.2%) of the remaining posterior fossa tumors were below the age of 15. 3. The author was able to make the correct plain film diagnosis of acoustic neuroma in 13 cases(51%) of 25 cases. The prominent angiographic and ventriculographic finding of posterior fossa tumors was ventricular dilatation. 4. Vntriculogram was very important in the diagnosis of the fourth ventricle tumors. The Conray ventriculogram had the special benefit in accurately outlining and demonstrating the invasive pattern of fourth ventricle tumors. The Conray showed C.S.F. flow in malignant and other large tumors in the fourth ventricle better than was shown by previous pneumo-ventriculograms. 5. The Electroencephalogram showed an abnormal pattern in 62.2 per cent of 29 posterior fossa tumors.
Astrocytoma ; Cysticercosis ; Diagnosis ; Diagnosis, Differential ; Dilatation ; Electroencephalography ; Ependymoma ; Female ; Fourth Ventricle ; Glioma ; Humans ; Infratentorial Neoplasms* ; Male ; Medulloblastoma ; Neuroma, Acoustic ; Neurosurgery ; Pathology ; Prognosis

OBJECTIVETo study clinicopathologic features, treatment and prognosis of pilocytic astrocytoma (PA).

METHODSHistopathological, ultrastructural, immunohistochemical (EnVision method) and clinical features of 68 cases of PA were studied by microscopic investigation with correlation of clinical follow-up information when available.

RESULTSThirty-five male patients and 33 female patients were studied. The patient's age ranged from 3 to 66 years (mean = 20.1 years). The mean time from symptom onset to surgery was 371 days (range, 3 days to 14 years). Cystic degeneration was noted in 41 cases (60.3%), and enhancement of the tumor was noted in 43 cases (87.8%). On postcontrast imaging examination there were 33 cases involving the cerebellum (48.5%). Total tumor excision was performed in 35 patients, subtotal tumor excision was performed in 31 patients, and the procedures of other 2 patients were not clear. Among 51 patients with follow-up information, 44 were alive, 7 had recurrent tumor, and 7 died. The post-operative survival ranged from 2 months to 124 months (mean survival = 48.1 months). Five years and ten years survival rates were 89%, respectively. Tumors with classic histopathology demonstrated biphasic pattern of growth, consisting of compact elongated bipolar astrocytes associated with rosenthal fibers, and less cellular areas of multipolar cells with granular bodies and microcyst. Some cases showed atypia of nuclei, and occasional mitoses. Involvement of subarachnoid space was seen in 17 cases. One case had anaplastic features. All cases showed diffuse positive staining for GFAP and low expression for Ki-67, except 1 anaplastic tumor with 10% Ki-67 indices. Tumors with subarachnoid space involvement showed positive reticular fiber staining and negative EMA staining.

CONCLUSIONSPA is a benign, WHO grade I tumor with favorable prognosis, and does not require radiotherapy after total resection. The tumor can be mistaken as higher-grade astrocytoma when involving the subarachnoid space, and with cytological atypia, leading to unnecessary radiotherapy after surgery. Recurrence rate is increased when only partial resection is achieved. The outcome for patients with brainstem tumor or anaplastic PA is poor.

Astrocytoma ; diagnosis ; genetics ; Brain Neoplasms ; diagnosis ; genetics ; Cell Nucleus ; pathology ; Female ; Glial Fibrillary Acidic Protein ; genetics ; Humans ; Male ; Prognosis ; Recurrence ; Treatment Outcome

OBJECTIVETo evaluate the apparent diffusion coefficients (ADC) in magnetic resonance diffusion weighted imaging with echo-planar technique in depicting the tumor cellularity and grading of astrocytoma.

METHODSThirty-four astrocytoma patients including 18 male and 16 female with age from 10 to 73 years (mean 38.4 years) were examined by MRI and eventually proved by surgical resection and pathological examination. Of them, 26 had low-grade (grade I, II) astrocytoma and 8 high-grade (grade III, IV) astrocytoma. ADC value of astrocytoma was determined on magnetic resonance diffusion weighted images. Cellularity of the astrocytoma was analyzed using Adobe Photoshop 7.0.1 software.

RESULTSThe mean ADC value (in units of 10(-4) mm(2)/s) of the high-grade astrocytomas (7.34 +/- 2.95) was significantly lower than that of the low-grade astrocytomas (13.76 +/- 3.31) (t = 4.91, P < 0.001). The mean cellularity of the high-grade astrocytomas (19.81 +/- 9.73)% was significantly higher than that of the low-grade astrocytomas (4.74 +/- 2.96)% (t = 4.32, P = 0.003). ADC value of the astrocytoma was significantly and negatively correlated with its cellularity (r = -0.535, P = 0.001).

CONCLUSIONADC value of astrocytoma is significantly and negatively correlated with its cellularity. Magnetic resonance diffusion weighted imaging may well be highly potential in predicting the degree of astrocytoma.

Adolescent ; Adult ; Aged ; Astrocytoma ; diagnosis ; pathology ; Brain Neoplasms ; diagnosis ; pathology ; Cell Count ; Child ; Diffusion Magnetic Resonance Imaging ; Female ; Glioblastoma ; diagnosis ; pathology ; Humans ; Image Processing, Computer-Assisted ; Male ; Middle Aged

OBJECTIVETo study the immunohistochemical expression and diagnostic significance of CD34 in brain tumors of patients with refractory epilepsy.

METHODSImmunohistochemical study for CD34 was performed on formalin-fixed paraffin-embedded tissue blocks of 54 cases of brain tumors occurring in patients with refractory epilepsy. The tumor types included ganglioglioma (GG, number = 21), dysembryoplastic neuroepithelial tumor (DNT, number = 8), tumors/lesions which had the transitional features that between glioneuronal hamartia and mixed neuronal-glial tumor (number = 21) and pleomorphic xanthoastrocytoma (PXA, number = 4). Cases of glioblastoma (number = 4) and oligoastrocytoma (number = 5) were used as controls.

RESULTSTwenty of the 21 cases of GG, 1 of the 8 cases of DNT, 16 of the 21 cases of tumors/lesions which had the transitional features and 3 of the 4 cases of PXA showed cytoplasmic and membranous positivity for CD34. The adjoining brain tissues in 9 of the 18 cases of GG, 6 of the 16 cases of tumors/lesions which had the transitional features and 1 of the 3 cases of PXA also expressed CD34. In contrast, only 1 case of glioblastoma showed membranous positivity for CD34.

CONCLUSIONSCD34 preferred to staining for GG and PXA. Which represent a valuable tool for distinguishing GG, PXA and DNT, oligoastrocytoma, glioblastoma.

Antigens, CD34 ; metabolism ; Astrocytoma ; complications ; metabolism ; pathology ; surgery ; Brain Neoplasms ; complications ; metabolism ; pathology ; surgery ; Diagnosis, Differential ; Epilepsy ; etiology ; Ganglioglioma ; complications ; metabolism ; pathology ; surgery ; Glioblastoma ; complications ; metabolism ; pathology ; Humans ; Neoplasms, Neuroepithelial ; complications ; metabolism ; pathology ; surgery