A marker for primary choroid plexus neoplasms.

Primary choroid plexus (CP) tumors are rare neoplasms that present in childhood or, less frequently, in adult life. The majority are benign and amenable to complete surgical excision, but occasionally more invasive variants are encountered. Although generally pathologically distinct, occasionally primary CP neoplasms may be difficult to distinguish from metastatic papillary carcinomas or papillary ependymomas. Conventional cytologic markers are not sufficiently specific to permit accurate diagnosis of primary CP tumors. The authors have reported that the CP is the unique site of synthesis within the brain of transthyretin (TTR, prealbumin), a transport protein for thyroxine and retinol. They therefore investigated the utility of TTR as a biochemical marker for CP tumors. They detected intense immunoreactivity for TTR at high dilutions of primary antiserum in the neoplastic epithelium of all of nine primary CP tumors (six papillomas and three carcinomas), but not in eight cellular or three papillary intracerebral ependymomas, meningiomas, oligodendrogliomas, astrocytomas, primary extracerebral papillary carcinomas (three thyroid, two breast) or five of six cerebral metastases from systemic papillary carcinomas. In one case of cerebral metastasis from papillary thyroid carcinoma, rare isolated immunoreactive cells were observed. Faint staining of the stromal-ependymal junction was seen in myxopapillary ependymomas of the filum terminale, which were otherwise nonreactive. By in situ hybridization, TTR mRNA was abundant in neoplastic CP epithelium, confirming local TTR synthesis. The authors conclude that TTR is synthesized by neoplastic CP epithelium and is an excellent marker for primary CP neoplasms.

[A case of large malignant choroid plexus papilloma in the third ventricle--immunohistochemical and ultrastructural studies].

A case of malignant choroid plexus papilloma (choroid plexus carcinoma) originated in the third ventricle is reported. A 14-month old girl was admitted to our department with two-month history of impaired vision and gait disturbance. Neurological examination on admission disclosed a lethargy, blindness, and left hemiparesis. Computed tomographic (CT) scan and magnetic resonance imaging (MRI) demonstrated a large contrast-enhancing mass, approximately 5 cm in diameter, in the region of third ventricle, extending to the bilateral lateral ventricles. The patient had gross total removal of the tumor via lateral ventricle route, and received 40 Gy of postoperative radiation therapy. Light microscopically, the tumor was composed of epithelial cells showing both papillary and poorly differentiated pattern. There were considerable cellular pleomorphism, frequent mitoses, and occasional necroses. Immunohistochemically, anti-keratin antibody was detected within majority of neoplastic cells. Both neoplastic epithelial cells and stroma showed negative reaction to anti-GFAP antibody. Ultrastructurally, the shape of the nuclei varied from ovale to irregular with many indentations. The chromatin was clumped around the periphery of the nuclei. The neoplastic cells contained numerous free ribosomes, glycogen granules, and rough endoplasmic reticulum. The apical cell surfaces showed various size of club-like or roundish microvilli filled with glycogen granules, and rarely 9 + 2 cilia. Elongated junctional complexes were occasionally seen near the apical ends. The basal portions of the cells had a continuous basement membrane. These immunohistochemical and ultrastructural findings were comparable to the choroid plexus papilloma with malignant features.(ABSTRACT TRUNCATED AT 250 WORDS)

[A clinicopathological study of central neurocytoma].

In 1982, Hassoun et al. reported two cases of differentiated neuroblastoma with the clinical and light microscopic appearance of intraventricular oligodendroglioma and gave a name of "central neurocytoma" to this tumor. Jerdan et al. (1983) called the similar tumor as "differentiated cerebral neuroblastoma in adults". As the tumor can be diagnosed only by ultrastructural study, the established cases so far reported are very rare. In this paper we present five cases identical to those presented by Hassoun et al. and clarify the essential nature of this new category of brain tumors. All of our cases of central neurocytoma occurred in the lateral ventricles of young adults. Clinically there was no evidence of leptomeningeal or ventricular dissemination of tumor cells. After subtotal resection of the tumor and 6000 rads of whole brain irradiation, the tumor mass disappeared and no evidence for recurrence of the tumor was noted on CT scan. All cases showed almost the same histology. The tumor cells contained a small round and/or oval nucleus, and had eosinophilic thin delicate cytoplasmic processes. There were no Homer Wright rosette, but were anuclear spaces consisting of fine fibrillar structures, like so called "broad rosettes" or "large rosettes". Capillary mesh was found among the tumor cells, but there was no endothelial proliferation. The tumor cells were monotonous, lacking pleomorphism, mitotic figures, and necrotic foci. Calcifications were observed in two cases. In the areas where the tumor cells arranged loosely, cytoplasms became clear, showing perinuclear halo, like those of oligodendrogliomas. Immunohistochemical examination showed GFAP and vimentin positive cells were all reactive astrocytes around capillaries and near calcifications. No tumor cells contained GFAP and vimentin. The tumor cells were also negative for neurofilament both of 70 KD and 200 KD. NSE was more or less positive for tumor cell cytoplasm as well as fine fibrils. Anti-Leu7 antibodies stained only fine cytoplasmic processes, but not cytoplasm. Some reactive astrocytes were stained with anti-Leu7 antibodies. Electron microscopic examination showed nuclei of the tumor cells were roughly round or oval without nuclear indentations and contained finely dispersed nuclear chromatin. In the cytoplasm, there were numerous free ribosomes, mitochondria, Golgi apparatus and electron dense various-shaped granules. Microtubules were found in the periphery of the cells, but filamentous structures were not identified.(ABSTRACT TRUNCATED AT 400 WORDS)

[Immunohistochemical study on distribution of transthyretin in normal human brain tissue and tumors].

Immunohistochemical examination of transthyretin (TTR), which is known to be synthesized in the epithelial cells of the choroid plexus as well as in the liver cells, was carried out on normal brain tissues and 84 human brain tumors, using a peroxidase-antiperoxidase (PAP) technique. TTR was demonstrated diffusely and strongly in the cytoplasm of normal choroid plexus cells, but not in ependyma and other tissues of normal brain. In all of 10 choroid plexus papillomas, TTR was found within the cytoplasm of tumor cells. In contrast, neither the two papillary ependymomas nor any other brain tumors contained TTR. Among the choroid plexus papillomas, some cases showed clear positive reactions in almost all tumor cells, while others had only a few TTR-positive cells. With these immunohistochemical findings, TTR proved a very useful marker of normal choroid plexus and choroid plexus papilloma.

A histologic and immunocytochemical study of choroid plexus tumors of the dog.

Sixteen choroid plexus (CP) tumors in 12 male and four female adult dogs were analyzed microscopically. Tumors were in the lateral (six), third (six), and fourth (four) ventricles. The average age of the dogs was 6 years. Tumors were classified by the following criteria: 1) choroid plexus papilloma (CPP), which resembled normal choroid plexus and had low mitotic activity; 2) choroid plexus papilloma (CPP), which resembled normal choroid plexus and had low mitotic activity; 2) choroid plexus papilloma with atypical features (atypical CPP), which had increased cellular density, nuclear atypia, two to four mitoses per 40x microscopic field, necrosis, and infiltration of the brain parenchyma and/or leptomeninges; and 3) choroid plexus carcinoma (CPC), which had marked nuclear atypia, poorly formed papillae, greater than four mitoses per 40x microscopic field, abnormal mitotic figures, and/or extraneural metastasis. The 16 tumors were classified either as CPP or atypical CPP (none as CPC). Statistically significant associations between brain infiltration and necrosis and atypical CPP were identified. Immunohistochemical studies in 11 tumors demonstrated staining for keratin in three tumors, two of which also reacted with carcinoembryonic antigen (CEA). There was no immunoreactivity with glial fibrillary acidic protein or epithelial membrane antigen. Choroid plexus from one of three control dogs stained focally for cytokeratin only. It is concluded that normal choroid plexus and CP tumors in the dog express epithelial, but not glial differentiation.

Ependymal and choroid plexus tumors. Cytokeratin and GFAP expression.

Twenty-six ependymal and 15 choroid plexus tumors were examined with monoclonal antibody against cytokeratin using the avidin-biotin-peroxidase complex (ABC) technique. Serial sections were examined with antisera to glial fibrillary acidic protein (GFAP). In five ependymal tumors (one ependymoma, two papillary ependymomas, and two primitive neuroectodermal tumors [PNET] with ependymal cells), a variable number of cytokeratin-positive cells were present. Most tumor cells (except two PNET) were positive with GFAP antisera. Many cytokeratin-positive cells were present in all choroid plexus tumors. GFAP-positive cells were present focally in six of 11 papillomas and in one of four carcinomas. Although their staining patterns and distribution were clearly different, focal coexistence of cytokeratin and GFAP was observed in six papillomas and two ependymal tumors. Thus, some ependymal tumors (especially papillary ependymomas and occasional PNET) and many choroid plexus tumors have demonstrable positivity with antibody to cytokeratin, suggesting a transitional cell type with features of both ependyma and choroid plexus.

An immunohistochemical study of cytokeratin and glial fibrillary acidic protein in choroid plexus papilloma.

Cellular localization of cytokeratin and glial fibrillary acidic protein (GFAP) was examined in two normal choroid plexuses and five choroid plexus papillomas by the peroxidase-antiperoxidase (PAP) method and double immunofluorescence (IFL) microscopy. Cytokeratin was observed in the majority of epithelial cells in all samples of normal and neoplastic choroid plexuses. On the other hand, GFAP was observed in some of the constituent epithelial cells in two cases of papilloma. Most of these GFAP-positive papilloma cells were simultaneously positive for cytokeratin, as could be seen by the PAP stainings of serial sections and by the double IFL stainings of the same sections. From these findings, it was suggested that normal and neoplastic choroid plexus epithelial cells usually express cytokeratin and that some of the neoplastic cells can simultaneously express both cytokeratin and GFAP.

Tumorigenesis in transgenic mice by a nuclear transport-defective SV40 large T-antigen gene.

The SV40(cT) mutant encodes a large tumor antigen (cT-ag) that is defective for transport from the cell cytoplasm into the nucleus. This mutant is able to transform established cell lines at near wild-type virus efficiencies, but has a markedly decreased ability to transform primary cells and to induce tumors in newborn hamsters (R. E. Lanford, C. Wong, and J. S. Butel, 1985, Mol. Cell. Biol. 5, 1043-1050). To explore the biology of transport-defective T-ag in vivo, transgenic mice carrying the cT-ag gene were produced. Five of eight founder animals died early in life of choroid plexus tumors (mean age +/- SE, 52 +/- 11.0 days); renal and thymic lesions were also observed. Mice of an SV40(cT) transgenic line regularly succumb to brain tumors (mean age, 81 +/- 1.2 days). SV40 T-ag is expressed in the tumor cells and is retained in the cytoplasm. The observation that SV40(cT) is equivalent to wild-type virus at tumor induction in transgenic mice emphasizes the probable importance of extranuclear forms of SV40 T-ag in brain tumor formation. This study also indicates that in vitro cell transformation assays may not always be accurate reflections of the oncogenic potential of a transforming gene in vivo, because of the different cell types involved.

Focal glial differentiation and oncocytic transformation in choroid plexus papilloma.

The histiopathological features of a choroid plexus papilloma in a 27-year-old male are described. The tumor displayed marked oncocytic transformation and glial differentiation of the epithelium in areas in which there was also marked sclerosis of the fibrovascular cores. Non-membrane-bound bodies of intermediate filaments characterized ultrastructurally the cells with glial differentiation.

Choroid plexus tumors in children: immunohistochemical and scanning-electron-microscopic features.

The 30 choroid plexus tumors recorded in a large pediatric tumor registry were reviewed. The 22 choroid plexus papillomas and 8 choroid plexus carcinomas represented 2.1% of all brain tumors in the registry. The patients (19 boys, 11 girls) were aged 3 months to 12 years (mean: 2 years 9 months). All tumors and four samples of normal choroid plexus were examined with conventional histology, 9 tumors were examined with electron microscopy and 24 using immunohistochemical techniques with antisera against glial fibrillary acidic protein, S-100 protein, epidermal cytokeratin, internal organ cytokeratin and carcinoembryonic antigen. Seven of the tumors (1 carcinoma and 6 papillomas) had some positive cells with antiserum against glial fibrillary acidic protein. Twenty-seven of the tumors (90%) and all normal choroid plexus samples were positive with antiserum to S-100 protein. Some tumor cells from both types of tumor and the normal choroid plexus reacted positively with internal organ cytokeratin antiserum, but all tissue samples were nonreactive with epidermal cytokeratin antiserum. Ultrastructurally, both papillomas and carcinomas displayed cytoplasmic intermediate filaments. Transmission and/or scanning electron microscopy revealed cilia in all choroid plexus papillomas. Frequently, the cilia had an abnormal arrangement, varying from 5 + 0 to 8 + 1. This study demonstrates that tumor cells of choroid plexus origin are characterized by the presence of S-100 protein and internal organ cytokeratin antiserum. Cilia, either normal or abnormal, are consistently identified in papillomas but rarely and with difficulty in carcinomas. Carcinoembryonic antigen is seen in choroid plexus carcinomas but not papillomas.

Serotonin 5-HT1C receptors are expressed at high density on choroid plexus tumors from transgenic mice.

Choroid plexus tumors develop spontaneously in adult transgenic mice carrying integrated copies of SV40 early region genes. In this communication, we report that these tumors exhibit the highest density of serotonin receptors (6600 fmol/mg protein) found in any tissue. 125I-LSD binding to choroid plexus tumors displays a pharmacological profile that matches the properties of 5-HT1C receptors in normal choroid plexus tissue. Autoradiographic localization of 125I-LSD binding in brain sections from transgenic mice shows high levels of labelling in the tumors, in correlation with immunohistochemical staining for SV40 large T antigen expression. Choroid plexus tumors from these transgenic mice provide an excellent model system for the study of serotonin 5-HT1C receptors.

Intermediate filament proteins in choroid plexus and ependyma and their tumors.

The intermediate filament protein types of normal choroid plexus and ependymal tissue and their putative tumors were investigated. In normal human choroid plexus tissue, but not in ependyma, keratin could be demonstrated immunohistochemically. By immunoblotting, keratins 8, 18, and 19 were found, but glial fibrillary acidic protein (GFAP) was absent. In mouse and rat, choroid plexus epithelium and ependymal lining cells were keratin-positive. In addition, many ependymal cells were vimentin-positive. Keratin was immunohistochemically found in three of four choroid plexus papillomas, two of two choroid plexus carcinomas, and the lining cells of three neuroepithelial cysts. GFAP-positive cells were present in some choroid plexus tumors. In contrast, none of the eight ependymomas contained keratin, but all were strongly positive for GFAP. The results show that choroid plexus lining cells and choroid plexus tumors have true epithelial characteristics in their cytoskeleton, in contrast to ependymomas, which do not show keratin positivity but show glial filaments, as would be seen in astrocytic tumors.

[Case of teratoma with intraventricular free fat].

Intracranial fat-containing congenital tumors are characterized by negative absorption values on computed tomography (CT). We are reporting a case of teratoma with intraventricular free fat diagnosed preoperatively by CT. The case is a 19-year-old female who was admitted to our hospital because of continuous severe headache, nausea and vomiting. At the time of admission, her physical and neurological examination was negative except for bilateral papilledema. CT demonstrated marked enlargement of the right lateral ventricle. In addition, there was negative absorption value (-90 H.U.), suggesting free fat, within right frontal horn layering above the CSF with a fluid level. metrizamide ventriculography demonstrated complete obstruction and revealed an irregular shadow defect at the right foramen of Monro. At surgery, yellowish cheese-like material, white hair was found on the surface of the CSF. Tumor arose from the floor of the right foramen of Monro and extended upward. The patient made an uneventful recovery and was discharged 17 days after surgery. Intraventricular free fat is likely that to be released from the teratoma cyst ruptured spontaneously when the patient complained of severe headache 40 days prior to admission. There have been several published reports of the CT appearances of intracranial fat-containing tumors, however, teratoma with intraventricular free fat is very rare. It was concluded that fat-containing tumors should be highly suspected, when negative absorption values were found on CT.

Focal ependymal differentiation in choroid plexus papillomas. An immunoperoxidase study.

Choroid plexus papillomas are usually easily distinguishable from papillary ependymomas by their delicate fibrovascular stroma and their cytologic similarity to normal choroid plexus epithelium. Exceptionally, however, examples are met which give rise to diagnostic difficulty. We therefore tested 22 choroid plexus papillomas for the presence of glial fibrillary acidic (GFA) protein using the immunoperoxidase technique. Positivity for the protein was found focally in epithelial tumor cells in nine of the 22 papillomas. All were in adults ranging from 19-66 years of age. Eight of the nine tumors originated in the 4th ventricle or one of its lateral recesses. In six papillomas showing GFA protein in the cells, intracellular fibrils were found in a small number of elongated epithelial cells with the PTAH and/or Masson trichrome stains; in all these six cases, the GFA protein-positive cells were considerably more numerous than cells containing fibrils. Normal choroid plexus epithelium lacks GFA protein, but pathologically altered ependymal cells are often GFA protein-positive. Our findings therefore suggest that focal divergent glial (presumably ependymal) differentiation may be expressed in neoplastic choroid plexus epithelium, consistent with the origin of this epithelium from primitive neuroepithelial (ventricular) cells.

[Primary endodermal sinus tumor of the fourth ventricle (author's transl)].

A case, a 18-year-old male, of an endodermal sinus tumor (yolk sac tumor) in the fourth ventricle, was reported. The patient had a month history of headache, vomiting and gait disturbance prior to the hospitalization, when he admitted to our service he was in lethargic condition with left cerebellar ataxia and horizontal nystagmus. Lumbar tap revealed clear CSF under normal pressure of 110 mm H2O with the CSF protein of 432.5 mg/dl and cell count of 147/3. The vertebral angiography demonstrated space occupying lesion in the posterior fossa. Plain CT demonstrated only disappearance of the fourth ventricle and slightly dilated bilateral ventricles and third ventricle. However diffuse high density area around the fourth ventricle was demonstrated and the wall of bilateral anterior horn was slightly enhanced, after injection of contrast media. There was no other abnormal findings around the pineal region. Suboccipital craniectomy was performed and the tumor was totally removed macroscopically. The tumor was situated in th floor of the fourth ventricle and infiltrated into the fourth ventricular wall and th adjacent cerebellar tissue. The tumor was with soft, greyish color and extremely vascular. Histologically the tumor was diagnosed as endodermal sinus tumor according to Teilum's classification. There were stellate cells arranged in a loose with vacuolated network which formed cystic cavities and a complicated network of honeycomb appearance with a system of communicating cavities and channels. Various size of intra- and extracellular PAS-positive hyaline globules were also seen. Glomerular-like structure (Schiller-Duval body) was not observed. Immunoperoxidase study clearly demonstrated the presence of intra- and extracytoplasmic alpha-fetoprotein granules in the tumor tissue. The amount of the serum alpha-fetoprotein, measured by radioimmunoassay, showed 400 ng/ml. After irradiation in the posterior fossa (5000 rad) the patient was discharged. Three months later, follow up CT demonstrated small high density area in the anterior horn of the left lateral ventricle, so he was rehospitalised. Irradiation in the whole brain was again administered. The tumor was very radiosensitive. CT, after 800 rad, demonstrated complete disappearance of the tumor. After irradiation totally (3000 rad), he discharged with left cerebellar ataxia.