In the field of computational histopathology, computer-assisted diagnosis systems are important in obtaining patient-specific diagnosis for various diseases and help precision medicine. Therefore, many studies on automatic analysis methods for digital pathology images have been reported. In this work, we discuss an automatic feature extraction and disease stage classification method for glioblastoma multiforme (GBM) histopathological images. In this paper, we use deep convolutional neural networks (Deep CNNs) to acquire feature descriptors and a classification scheme simultaneously. Further, comparisons with other popular CNNs objectively as well as quantitatively in this challenging classification problem is undertaken. The experiments using Glioma images from The Cancer Genome Atlas shows that we obtain 96:5% average classification accuracy for our network and for higher cross validation folds other networks perform similarly with a higher accuracy of 98:0%. Deep CNNs could extract significant features from the GBM histopathology images with high accuracy. Overall, the disease stage classification of GBM from histopathological images with deep CNNs is very promising and with the availability of large scale histopathological image data the deep CNNs are well suited in tackling this challenging problem.
Classification* ; Diagnosis ; Diagnosis, Computer-Assisted ; Genome ; Glioblastoma* ; Glioma ; Methods ; Pathology ; Precision Medicine ; Subject Headings

Brainstem glimas are common intracranial tumors in young age and have dismal prognosis despite the advance in diagnostic and treatment modalities. The purpose of this study is to classify the brainstem gliomas by growth patterns and to correlate the growth patterns with histological findings. With these results,we have studied further to verify the prognostic factors in brainstem gliomas. Sixty four patients with brainstem gliomas were treated between May, 1989 and March, 1997. For the location of brainstem gliomas, 41 cases were in pons, 13 cases in medulla, 8 cases in midbrain, and 2 disseminated cases. Operations were performed in 44 cases of these lesions which were focally enhanced type or had exophytic growth patterns. Histological diagnoses were low grade gliomas in 22 cases and high grade gliomas in 21 cases. Among them, radiotherapy was performed in 39 patients with diffuse or disseminated type. Among operated pateints, seven were treated with Gamma Knife radiosurgery for focal residual lesion. Diffuse types were more common in pons. Exophytic or focal types were common in medulla and midbrain. High grade glioma was more common in diffuse type and low grade glioma was common in exophytic or focal type. We concluded that the favorable prognostic factors are long duration of symptoms(>2mos), exophytic type, low grade glioma, and radiotherapy treatment.
Brain Stem* ; Classification* ; Diagnosis ; Glioma* ; Humans ; Mesencephalon ; Pathology ; Pons ; Prognosis* ; Radiosurgery ; Radiotherapy

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

Chordoid glioma is a rare low grade tumor typically located in the third ventricle. Although a chordoid glioma can arise from ventricle with tumor cells having features of ependymal differentiation, intraventricular dissemination has not been reported. Here we report a case of a patient with third ventricular chordoid glioma and intraventricular dissemination in the lateral and fourth ventricles. We described the perfusion MR imaging features of our case different from a previous report.
Adult ; Cerebral Ventricle Neoplasms/diagnosis/pathology/*secondary ; Fourth Ventricle/*pathology ; Glioma/diagnosis/*pathology ; Humans ; Lateral Ventricles/*pathology ; Magnetic Resonance Imaging/methods ; Male ; Third Ventricle/*pathology

Brain Neoplasms ; diagnosis ; metabolism ; pathology ; Child ; Diagnosis, Differential ; Female ; Glioma ; pathology ; Humans ; Immunohistochemistry ; Magnetic Resonance Imaging ; Meningioma ; diagnosis ; metabolism ; pathology ; Mucin-1 ; metabolism ; Occipital Lobe ; Vimentin ; metabolism

Subependymoma is a rare, slow-growing, benign noninvasive tumor of the central nervous system that may be located in the fourth ventricle, the septum pellucidum, the third and the lateral ventricles, the aqueduct, and the proximal spinal cord. Symptoms, if any, usually result either from direct compression of the brain stem or from acute hydrocephalus due to occlusion of the foramen of Monro or aqueduct of Sylvius. In this report, we describe a case of subependymoma of the lateral ventricle with headache in a young female patient. This is the first reported case subependymoma in Korea that was documented along with Magnetic resonance image.
Adult ; Cerebral Ventricle Neoplasms/*diagnosis/pathology ; Female ; Glioma/*drug therapy/pathology ; Headache/complications ; Humans ; Magnetic Resonance Imaging

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

The advant of computerized cranial tomography represents a great advance in the diagnosis of very wide varietyof intracranial lesions. The CT findings of brain tumors have been reported by many authors, especially by Hatamin early contrast enhancement and evaluation of the intracranial lesions. A statistical analysis was performedwith 84 brain tumors cases of with diagnoses were confiremd at the department of Radiology and Pathology of theMiddlesex Hospital London from Jan. 1979 to Dec. 1980. The authors classified the intracranial tumors according toRussel and Rubinsteins classification, and especially for the changes after CT introduction. The results were asfollows; 1. Brain tumors were found most frequently in middle age group (25.7%) and the ration of male to femalwas 2:1. 2. Among the brain tumors, gliomas were found most frequently (57.1%), followed by Meningioma(20.2%),Metastatic tumors(11.9%), and pituitary adenomas (4.8%). 3. The incidence of glioma occupied(57.1%) of all braintumors and as a entity these were the highest. 4. Brain tumors occured more fequently in frontal regions (27.4%),parietal regions(17.0%), sella and para sella-regions(11.9%), cerebellum regions(9.5%). 5. Gliomas occured morefrequently inn temporal regions (20.2%) and followed by frontal regions (16.7%). 6. Since the advant of CT scan,the detection rate of brain tumors was increased, but there was no specific change in proportion of tumors.
Brain Neoplasms ; Brain ; Cerebellum ; Classification ; Diagnosis ; Glioma ; Humans ; Incidence ; Male ; Middle Aged ; Pathology ; Pituitary Neoplasms ; Temporal Lobe

Papillary ependymoma is a rare variant of ependymoma and often gives rise to confusion with choroid plexus papilloma because of topographic, light microscopic and ultrastructural similarities. Here, we report two cases of papillary ependymomas regarding their unique clinicopathologic features and differential points from choroid plexus papilloma. Brain MRI revealed a large mass in the left lateral ventricle in one case and a 3cm sized mass in the pineal area and the 3rd ventricle in the other. Microscopically, the tumor was characterized by papillary and tubular structures. Immunohistochemically, the tumor cells in both cases expressed cytokeratins(CK22 and CAM 5.2) but did not express glial fibrillary acidic protein(GFAP), vimentin, epithelial membrane antigen, and S100 protein. This is a very unusual immunohistochemical feature for papillary ependymoma. Ultrastructurally, the tumor showed a mosaic pattern of tumor cells with frequent intercellular microrosettes having a few stubby microvilli, a few cilia and zonulae adherentes. The cytoplasmic processes were markedly reduced compared to conventional ependymoma. The cytoplasm did not contain intermediate filaments. Interestingly, the mitochondria showed abnormal features with a pleomorphic shape and abnormal cristae in both cases. These ultrastructural features enabled differentiation between papillary ependymoma and choroid plexus papilloma in addition to the light microscopic findings.
Adult ; Carcinoma, Papillary/*pathology/surgery ; Case Report ; Diagnosis, Differential ; Ependymoma/*pathology/surgery ; Fatal Outcome ; Female ; Follow-Up Studies ; Glioma/*pathology ; Human ; Magnetic Resonance Imaging ; Middle Age

OBJECTIVETo study the clinicalpathologic features of intracranial multiple lesions.

METHODSThe clinical, radiologic and pathologic features of intracranial multiple lesions in 62 cases during the period from 2005 to 2009 in Xuanwu Hospital were retrospectively reviewed.

RESULTSThere were 32 males and 30 females in 62 cases. The mean age of seize onset and duration of disease were 37.4-year-old and 11.6 months, respectively. The lesions could affect cerebral hemisphere, basal ganglia, brain stem, cerebellum and other parts, most lesions were located above the tentorium. Pathological diagnosis as follows: 13 patients with glioma; metastatic tumors in 13 cases; 12 cases of central nervous system infection; immune-mediated inflammatory demyelinating disease in 8 cases; 5 cases of primary lymphoma of central nervous system; primary angiitis of the central nervous system 3 cases; mitochondrial encephalopathy 2 cases; vein thrombosis in 2 cases; Rosai-Dorfman disease in 2 cases; 2 case of radiation encephalopathy. Among them, mitochondrial encephalopathy and vein thrombosis lesions located in the cortex; metastatic tumor and blood-borne infection mainly involving junction of grey and white matter; glioma, radiation encephalopathy and demyelinating disease include white matter lesions; vascular inflammation showed cortical and subcortical white matter lesions.

CONCLUSIONSA variety of tumor and non-neoplastic diseases can be expressed in intracranial multiple lesions, which gliomas, metastatic tumor and central nervous system infections are more common. In order to improve the diagnosis of intracranial multiple lesions, active work in the brian biopsy, study the clinical, imaging and pathological findings must be closely.

Adolescent ; Adult ; Aged ; Brain Neoplasms ; diagnosis ; pathology ; surgery ; Child ; Demyelinating Diseases ; diagnosis ; pathology ; surgery ; Female ; Glioma ; diagnosis ; pathology ; surgery ; Histiocytosis, Sinus ; diagnosis ; pathology ; surgery ; Humans ; Lymphoma, Large B-Cell, Diffuse ; diagnosis ; pathology ; surgery ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Neoplasms, Neuroepithelial ; diagnosis ; pathology ; surgery ; Retrospective Studies ; Toxoplasmosis, Cerebral ; diagnosis ; pathology ; surgery ; Tuberculosis, Central Nervous System ; diagnosis ; pathology ; surgery ; Young Adult