PMC3690632_01
(a) A sagittal postgadolinium T1-weigthed image shows the two lesions before surgery. (b) The tumor at level C7-T1 in T2-weigthed image. (c) In cranial T1-weighted image, the small tumor is located on the floor of the third ventricle. (d) T1-weighted image shows the postoperative result.
CRIM.NM2013-925647.001.jpg
PMC3690632_01_CRIM.NM2013-925647.001.jpg
fig1
T8-T9 vertebral levels (Figures 1(a) and 1(b)). The large lesion at the level of C7-T1 was completely removed via laminectomy. In March 2007, removal of the tumor located at the T8-T9 vertebral level was undertaken (Figure 1(d)). This revealed a contrast enhancing intracerebral mass in the third ventricle (Figure 1(c)).
Tumor histomorphology at different time points. (a) In 2007, excised mostly monomorphic highly cellular tumor with regular rounded nuclei and only few mitoses. The blood vessels are regularly arranged resembling a loose meshwork without pathological endothelial proliferation or glycogen storage. (Periodic acid Schiff (PAS), Magnification original x20.) (b) Immunostaining for the proliferation marker K67 (MIB-1) showing only few proliferating cells (indirect peroxidise technique (LSABII, DAKO, diaminobenzidine (DAB) as a chromogen, brown, Magnification orig. x20, counterstaining with Hematoxylin)). (c) Immunostaining for beta-III-Tubulin (Chemicon), a marker of immature neural cells with strong positivity of all tumor cells. (LSABII, DAKO, (DAB), counterstaining with Hematoxylin Magnification orig. x20.) (d) Immunostaining for the neuronal marker synaptophysin (Dako) with strong positive staining of all tumor cells. (LSABII, DAKO, (DAB), counterstaining with Hematoxylin Magnification orig. x20.) (e) Immunostaining for chromogranin (Dako), a marker of highly differentiated neuronal cells and ganglion cells with mostly negative staining results. (LSABII, DAKO, (DAB), counterstains with Hematoxylin Magnification orig. x20.) (f) Immunostaining for S100 (Dako) showing a mostly negative staining result with single positive cells of glial morphology at irregular intervals (LSABII, DAKO, (DAB), counterstaining with Hematoxylin Magnification orig. x20.) (g) Tumor biopsy of 2006 with similar morphology of lower cellularity. Noteworthy are the occasional cell-free areas. (H&E, Magnification original x10.) (h) Tumor biopsy of 1992 showing similarly organized tumor cells with rounded nuclei and even less mitoses within an extensive hemorrhage. (H&E, Magnification original x20.)
CRIM.NM2013-925647.002.jpg
PMC3690632_01_CRIM.NM2013-925647.002.jpg
fig2
Histology demonstrated a mostly monomorphic, highly cellular tumor with rounded chromatin intense nuclei, mostly without nucleoli or mitoses (Figures 2(a) and 2(b)). Immunohistochemistry revealed a strong positive reaction for the neuronal marker synaptophysin and for the antibody to betaIII Tubulin (Figures 2(c) and 2(d)) demonstrating mostly immature neurons in 100% of the tumor cells. Chromogranin, a marker for mature, differentiated neurons and ganglion cells, was mostly negative (Figure 2(e)). GFAP (not shown) and S100 were mostly negative with the exception of single cells of glial morphology (Figure 2(f)). Only few proliferating cells (up to 5% maximum) could be ascertained with the marker Ki67/MIB-1 (Figure 2(b)). In comparison, the tumor tissues excised in 2006 showed a similar tumor pattern, with slightly lower cellularity and perivascular nucleus-free neuropil, typical of neurocytoma (Figure 2(g)). Slides of the tumor excised in 1992 also showed a similar morphology (Figure 2(h)) and a similar reaction pattern, with a slightly lower proliferation rate as compared to 2007, and a negative immunoreaction for GFAP (not shown).