title: Pediatric glioblastoma with giant cells and "supratentorial" primitive neuroectodermal component - case report and review of the literature.
abstract: BACKGROUND
  The glial differentiation in pediatric "supratentorial primitive neuroectodermal tumors" (sPNET) is occasionally revealed by immunohistochemistry with GFAP (glial fibrillary acidic protein) as isolated positive cells among undifferentiated cells, indicative of divergent cellular phenotypes. Large malignant glial tumors in sPNETs are extremely rare and challenge the neuropathologist by raising the possibility of glioblastomas with sPNET-like features (GB sPNET). The distinction between them is important because of their different treatment and prognostic.
  
  
  METHODS
  A large parieto-occipital tumor with minimal ventricular invasion, in an 11-year-old girl, with a five-month clinical history, was proven to be a highly malignant biphasic tumor, consisting in a glioblastoma with giant cells, representing 75% of the tumor, and sPNET nodules, with one larger dominant nodule. The immunohistochemistry confirmed positivity for synaptophysin, neurofilament, neuron-specific enolase and CD56 in the sPNET compartment and for GFAP, CD56 and vimentin in the glioblastoma. In some parts of the tumor, the two components were well delineated from each other as in a "collision" tumor, but in others, the two different tumors were intermingled. It was histologically diagnosed as sPNET with double differentiation (glial and neural) or glioblastoma with sPNET-like features.
  
  
  CONCLUSIONS
  These cases are very rare, few reported, especially in the pediatric population, and with high difficulties in histological differential diagnosis, subsequently reflected in the therapeutic decisions.
authors.affiliation: Discipline of Histology, Department of Morphological Sciences, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania; a_sovrea@yahoo.com.
authors.forename: Carmen
authors.initials: C
authors.lastname: Georgiu
authors.forename: Emilia
authors.initials: E
authors.lastname: MihuŢ
authors.forename: Iulian
authors.initials: I
authors.lastname: Raus
authors.forename: Ştefan Claudiu
authors.initials: ŞC
authors.lastname: Mirescu
authors.forename: Laura
authors.initials: L
authors.lastname: Szabo
authors.forename: Alina Simona
authors.initials: AS
authors.lastname: Şovrea
mesh_terms: D001932:Brain Neoplasms / Q000473:pathology*; D002648:Child; D005260:Female; D015726:Giant Cells / Q000473:pathology*; D005909:Glioblastoma / Q000473:pathology*; D006801:Humans; D007150:Immunohistochemistry; D008279:Magnetic Resonance Imaging; D015173:Supratentorial Neoplasms / Q000473:pathology*