Pediatric malignant glioma with tubuloreticular inclusions and MYCN amplification. Report of a case with immunohistochemical, ultrastructural, flow cytometric, karyotypic, and Southern blot analysis.
BACKGROUND
The authors described unusual pathologic features in a left frontal lobe malignant glioma in a 31/2-year-old boy. The pathology was similar in the initial excision and two subsequent recurrences at 9 and 11 months and at autopsy, when extensive subarachnoid spread was noted.


METHODS
The tumor was studied by conventional histology, immunohistochemistry, flow cytometry, transmission electron microscopy (TEM), immune electron microscopy (IEM), and cytogenetic and Southern blot analysis.


RESULTS
The tumor revealed two different histologic patterns. One component showed large cells with eosinophilic cytoplasm, vesicular nuclei with prominent nucleoli, eosinophilic perinuclear inclusions, and immunoreactivity for glial fibrillary acidic protein (GFAP) and vimentin. The other component consisted of undifferentiated cells with hyperchromatic nuclei and scanty cytoplasm. By TEM, the perinuclear aggregates were composed of tubuloreticular inclusions, which were also observed in endothelial cells within the tumor vasculature. By IEM, the intermediate filaments in the tumor cell cytoplasm were decorated with GFAP. Flow cytometric results revealed a marked increase in the S-phase (48%), whereas cytogenetic analysis of short-term cultures showed an abnormal karyotype containing marker chromosomes and double minutes. In the second resection, additional karyotypic abnormalities were noted, including 1p- and several additional markers. The first and second resections showed MYCN amplification by Southern Blot analysis in the 60- to 80-fold range.


CONCLUSIONS
This tumor presents unique histologic, ultrastructural, and cytogenetic findings as well as MYCN amplification that is notable for a pediatric malignant glioma. Tubuloreticular inclusions were a prominent feature in this tumor, which again is unique for a glioma.
Jay
V
V
Department of Pathology, Hospital for Sick Children-University of Toronto, Ontario, Canada.
Rutka
J
J
Becker
L E
LE
Squire
J
J
D015139:Blotting, Southern; D001932:Brain Neoplasms / Q000235:genetics* / Q000648:ultrastructure*; D002467:Cell Nucleus / Q000648:ultrastructure; D002675:Child, Preschool; D002869:Chromosome Aberrations / Q000235:genetics; D002872:Chromosome Deletion; D025063:Chromosome Disorders; D003593:Cytoplasm / Q000648:ultrastructure; D004730:Endothelium, Vascular / Q000648:ultrastructure; D005434:Flow Cytometry; D005625:Frontal Lobe / Q000648:ultrastructure; D015972:Gene Expression Regulation, Neoplastic; D016259:Genes, myc / Q000235:genetics*; D005904:Glial Fibrillary Acidic Protein / Q000032:analysis; D005910:Glioma / Q000235:genetics* / Q000648:ultrastructure*; D006801:Humans; D007150:Immunohistochemistry; D002479:Inclusion Bodies / Q000648:ultrastructure; D007621:Karyotyping; D008297:Male; D008928:Mitochondria / Q000648:ultrastructure; D008938:Mitosis; D014746:Vimentin / Q000032:analysis
D005904:Glial Fibrillary Acidic Protein; D014746:Vimentin