J Pathol Transl Med.  2015 Nov;49(6):427-437. 10.4132/jptm.2015.09.19.

The Continuing Value of Ultrastructural Observation in Central Nervous System Neoplasms in Children

• Kim NR
• Park SH

• KMID: 2381402
• DOI: http://doi.org/10.4132/jptm.2015.09.19

Abstract

Central nervous system (CNS) neoplasms are the second most common childhood malignancy after leukemia and the most common solid organ neoplasm in children. Diagnostic dilemmas with small specimens from CNS neoplasms are often the result of multifactorial etiologies such as frozen or fixation artifact, biopsy size, or lack of knowledge about rare or unfamiliar entities. Since the late 1950s, ultrastructural examination has been used in the diagnosis of CNS neoplasms, though it has largely been replaced by immunohistochemical and molecular cytogenetic studies. Nowadays, pathologic diagnosis of CNS neoplasms is achieved through intraoperative cytology, light microscopy, immunohistochemistry, and molecular cytogenetic results. However, the utility of electron microscopy (EM) in the final diagnosis of CNS neoplasms and investigation of its pathogenetic origin remains critical. Here, we reviewed the distinguishing ultrastructural features of pediatric CNS neoplasms and emphasize the continuing value of EM in the diagnosis of CNS neoplasms.

Keyword

Microscopy, electron; Central nervous system; Neoplasms; Childhood

MeSH Terms

Artifacts
Biopsy
Central Nervous System Neoplasms*
Central Nervous System*
Child
Cytogenetics
Diagnosis
Humans
Immunohistochemistry
Leukemia
Microscopy
Microscopy, Electron

Figure

• 

  Fig. 1. (A) Meningioma shows closely apposed oval- to spindle-shaped tumor cells having interdigitating cell processes lined by well-formed desmosomes (×8,000). Inset indicates tonofibrils attached to the desmosomal plaques (×30,000). (B) Schwannoma shows abundant reduplicated continuous basal lamina surrounding the interdigitating cell processes (×3,500). Note the extracellular long-spacing collagen (arrow) and high power view of reduplicated basal lamina (inset, ×6,500). (C) Ependymoma reveals spindle cells with numerous cytoplasmic processes filled with bundles of intermediate filaments (×4,000). Inset shows well-formed zonula occludens with surface microvilli (×15,000). (D) Pilomyxoid astrocytoma shows bipolar cells with surface microvilli and cilia in the electron-lucent extracellular space (×9,000). Note some intracellular microlumen. (E) Astrocytoma shows loosely scattered round to oval cells having numerous long cytoplasmic processes filled with bundles of glial filaments and scarce other organelles (×2,500). (F) Glioblastoma shows many pleomorphic spindle and oval cells with numerous cytoplasmic processes containing bundles of intermediate filaments with surface microvilli-like differentiation (×2,500). (G) Medulloblastoma shows that loosely arranged oval-shaped tumor cells project cytoplasmic processes forming rosettes filled with glial filaments and dense core granules indicating neuroglial differentiation (×9,000). (H) Neuroblastoma reveals that closely packed polygonal to spherical tumor cells have numerous, thin, electron-lucent cell processes forming an interlacing meshwork between groups of cell bodies (×9,000). Inset shows longitudinally-oriented 20 nm microtubules (white arrow) and dense core granules (black arrow, ×15,000). (I) Primitive neuroectodermal tumor reveals round to closely apposed oval-shaped tumor cells with abundant cytoplasmic processes containing sparse organelles including glycogen particles, mitochondria, and some microtubules (×8,000).(J) Atypical teratoid and rhabdoid tumor reveals paranuclear aggregates of intermediate filaments (arrow) compressing the heterochromatic nuclei (×15,000). (K) Oligodendroglioma presents tumor cells with uniform round nuclei and sparse cytoplasmic organelles as well as some irregularly shaped cell processes (arrow) containing occasional globoid collections of intermediate filaments (×3,500). (L) Neurocytoma reveals round tumor cells with a moderate amount of cytoplasm and numerous long thin cell processes containing microtubules, few electron dense core granules and secretory vesicles (arrow), and glial intermediate filaments (×8,000). (M) Dysembryoplastic neuroepithelial tumor reveals oligodendroglial-like cells with elongated bulbous cell processes forming a neuropil-like structure filled with intermediate filaments in electron-lucent mucoid extracellular spaces (×7,000).(N) Papillary tumor of the pineal region reveals polygonal-shaped tumor cells having short-villous cell surfaces and cytoplasm having abundant rough endoplasmic reticulums with distended cisternae and vacuoles (×3,500). (O) Chordoid glioma of the third ventricle reveals tumor cells with cytoplasmic processes filled with intermediate glial filaments and surrounded by basal lamina (×7,000). Note the numerous surface microvilli (arrow). (P) Choroid plexus papilloma shows ovoid to polygonal tumor cells arranged in glandular patterns joined by well-formed junctional complexes and a continuous basal lamina (arrow) surrounding these glandular structures (×1,500). Note the apical portion of tumor cells lined by numerous microvilli and cilia composed of 9+2 microtubules.

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