title: A reassessment of histologic classification and an immunohistochemical study of 88 retinoblastomas. A special reference to the advent of bipolar-like cells.
abstract: BACKGROUND
  Despite perpetual efforts of investigators, the histogenesis of retinoblastoma is still in dispute and histologic classification satisfactorily predictive of prognosis does not seem to be in use.
  
  
  METHODS
  The authors studied 88 cases of retinoblastoma clinicopathologically and immunohistochemically, paying special attention to the presence of a "bipolar-like cell" element that would be used as one of the criteria for the diagnosis of differentiated retinoblastoma.
  
  
  RESULTS
  Twelve cases of retinoblastoma with the bipolar-like cell element in the absence of rosettes and 41 cases of the tumor with rosettes were classified as differentiated retinoblastomas. The other 35 cases without rosettes or bipolar-like cells were classified as undifferentiated tumors. Tumor cells forming rosettes usually had positive results for synaptophysin and neuron-specific enolase (NSE) and negative results for glial fibrillary acidic protein (GFAP) and S-100 protein; however, undifferentiated cells had negative results for these four antibodies. The bipolar-like cells had positive results for synaptophysin and NSE but negative results for GFAP and S-100 protein. Twelve tumors with bipolar-like cells that lacked rosettes showed no optic nerve invasion, and the patients had a significantly better prognosis (100% 5-year survival rate) than 35 patients with undifferentiated tumors (71% 5-year survival rate) (P < 0.01).
  
  
  CONCLUSIONS
  The findings support a neuronal origin of the tumor and indicate that, not only the rosettes symbolizing the photoreceptor differentiation, but also other neuronal elements, such as bipolar-like cells, can be used as criteria for histologic classification of retinoblastoma.
authors.affiliation: Second Department of Pathology, Faculty of Medicine, Kyushu University, Fukuoka, Japan.
authors.forename: W
authors.initials: W
authors.lastname: He
authors.forename: H
authors.initials: H
authors.lastname: Hashimoto
authors.forename: M
authors.initials: M
authors.lastname: Tsuneyoshi
authors.forename: M
authors.initials: M
authors.lastname: Enjoji
authors.forename: H
authors.initials: H
authors.lastname: Inomata
mesh_terms: D000293:Adolescent; D002454:Cell Differentiation / Q000502:physiology; D002675:Child, Preschool; D005260:Female; D005904:Glial Fibrillary Acidic Protein / Q000032:analysis; D006801:Humans; D007150:Immunohistochemistry; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010751:Phosphopyruvate Hydratase / Q000032:analysis; D011379:Prognosis; D012175:Retinoblastoma / Q000737:chemistry / Q000209:etiology / Q000473:pathology*; D009418:S100 Proteins / Q000032:analysis; D016708:Synaptophysin / Q000032:analysis
chemical_list: D005904:Glial Fibrillary Acidic Protein; D009418:S100 Proteins; D016708:Synaptophysin; D010751:Phosphopyruvate Hydratase