Histological Typing of Tumours of the Central Nervous System


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The New WHO Classification of Brain Tumours

He added new pathological information after previous papers Cushing, ; Kernohan et al. Similarly, he observed that oligodendrocytes tend to be arranged in dense or diffuse patterns and never in perivascular patterns. The tumors described at this level that can be classed as gliomas, which were similar to brain tumors, with a moderately expansive or infiltrative character.

The several cell types that can be identified for tumors of the optic nerve and chiasm include the following: 1 cells with small, round nuclei; 2 cells with bipolar, spindle-shaped, and long nuclei; 3 cells with a tripolar cytoplasm and thick prolongations; 4 cells with multipolar cytoplasm and fibroid and undulating prolongations; 5 cells with multipolar cytoplasm that invade the vasculature.

Current classifications of nervous system tumors are mixed, based on cytological and histogenetic criteria, as well as on histopathological variants that are of clinical and prognostic importance. This classification serves as the basis for the subsequent editions of the World Health Organization classification until the year and the subgroups that are currently being incorporated.

The most notable new additions are as follows:.

Associated Data

A distinction is also made between oligodendroglial tumors and oligoastrocytic tumors [oligoastrocytomas and anaplastic malignant oligodendrogliomas]. Within the ependymal tumors and colloid plexus tumors, it is important to distinguish between variants of ependymomas, such as myxopapillary ependymoma, papillary ependymoma, subependymoma, and anaplastic ependymoma.

At the level of the colloid plexus, we must distinguish between colloid plexus papilloma and colloid plexus carcinoma. The neuronal tumors include variants such as gangliocytoma, ganglioglioma, ganglioneuroblastoma, gangliocytoma, anaplastic malignant ganglioglioma, and neuroblastoma.


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Among the poorly differentiated and embryonal tumors it is important to identify glioblastoma with its two subvariants, glioblastoma with a sarcomatous component and giant cell glioblastoma , medulloblastoma, medulloepithelioma, primitive polar spongioblastoma, and gliomatosis cerebri. The classification covers tumors of the meningeal and related tissues, such as meningioma, with at least 11 morphological variants depending on the predominance of the Schwann, angiomatous, and papillary component.

Similarly, the anaplastic malignant variant of meningioma is a distinct entity. The classification still includes vascular tumors e. The previously cited group of malformative tumors and tumor-like lesions is extended to include enterogenic cysts, lipoma, hypothalamic neuronal hamartoma, nasal glial heterotopia nasal glioma , as well as various vascular malformations capillary telangiectasia, arteriovenous malformations, and Sturge-Weber disease.

The classification continues to include new entities, mainly anatomical-clinical conditions where it is very important to distinguish between gliomas with a high and low degrees of malignancy based on cytological criteria. The new types of low-grade glioma described include angiocentric gliomas, which are variants of glioneuronal tumors e.

We can also distinguish between pilocytic tumors and their pilomyxoid variants, which have a poorer clinical prognosis Louis et al. In the coming years, it will be necessary to add the molecular abnormalities underlying the transformation and malignancy of these tumors. Our knowledge is expected to increase thanks to amplification of genes such as EGFR in glioblastoma, loss of alleles on chromosomes 1p and 19p in oligodendroglioma, and mutations in genes such as in p53 and IDH1 in low-grade astrocytoma that progresses to malignant astrocytoma.

Intra- and inter-tumoral heterogeneity could be understood as resulting from cancer stem cells and the accumulation of various molecular abnormalities. As has occurred with other types of tumor, especially lymphoma, whose classifications have for decades been based merely on morphological or clinical criteria, a joint approach to classification is probably the most suitable for clinical practice.

Cytological abnormalities, location, and histopathological characteristics could facilitate a more in-depth study of the various types of tumor. It is important to remember that the major objective of any classification is that the information it provides be of use in clinical practice. Only thus can the patient receive the best and most personalized treatment possible. The author confirms being the sole contributor of this work and approved it for publication.

The author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. Bailey, P. A study of tumors arising from ependymal cells.

Histological Typing of Tumours of the Central Nervous System

Psychiatry 11, 1. Oligodendrogliomas of the brain. Google Scholar. Medulloblastoma cerebelli. A commontype of mid cerebellar glioma of childhood. Psychiatry 14, Lippincott Company.

CNS Tumors

Cornil, L. Cushing, H. Philadelphia, PA; London: W. Saunders company. Diaz, P. Madrid: CSIC. Globus, J. Spongioblastoma multiformea primary malignant form of brain neoplasm: its clinical and anatomic features. Psychiatry 14, — Kernohan, J. Psychiatry 29, Intramedullary tumors of the spinal cord. A review.

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Psychiatry 25, Lhermitte, J. Louis, D. The WHO classification of tumours of the central nervous system. Acta Neuropathol. Miller, R. Supratentorial tumors among children. AMA Arch. Psychiatry 68, — PubMed Abstract Google Scholar. Obrador, S.

Ortiz de Picon, J. Pio del Rio-Hortega. Penfield, W.

A paper on classification of brain tumors and its pratical application. Pineda, A. Polak, M. Ribbert, H. Neuroepithel in Gliomen. Virchow Arch. Las Epiteliofibrillas. Madrid: Trab. Del Lab. De Inv. De la Univ. III, — III , — Libro homenaje a Goyanes, febrero. Trabajos del Lab. De Histopat. Buenos Aires: Bol. Discussion on tumors of the optic nerve. Del glioepitelioma al glioblastoma isomorfo.

Y Pat. III, XXIV, 7. IV, I, — II, — Tumors of central nervous system have unique characteristics that set them apart from neoplastic processes elsewhere in the body. The frequency and location of CNS tumors in children differ from that in adults. Histological type of tumors is also different in children and adults. The diagnosis in was made on HPE of routinely processed tissue.

Neurosurgical specimens constitute 7. Among a total number of 72 major CNS neoplastic lesions, supratentorial lesions were 42 There were 6 8.

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Among spinal cord lesions, 3 were meningiomas, one was schwannoma and 2 were neurofibromas. The two lesions from suprasellar region were pituitary adenomas. Next in frequency was meningioma. Among a total of 20 meningeomas, 17 were located intracranially and 3 were situated in spinal cord region. Among 72 cases, 32 were benign and 40 were malignant. Apart from intervertebral discs and congenital malformations, tuberculous infection is also important lesion. In our study incidence of low grade astrocytomas were the commonest of all gliomas and fibrillary astrocytoma was the frequent histological type among astrocytomas.

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Histological Typing of Tumours of the Central Nervous System Histological Typing of Tumours of the Central Nervous System
Histological Typing of Tumours of the Central Nervous System Histological Typing of Tumours of the Central Nervous System
Histological Typing of Tumours of the Central Nervous System Histological Typing of Tumours of the Central Nervous System
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