Showing papers by "Peter C. Burger published in 1983"

Computerized tomographic and pathologic studies of the untreated, quiescent, and recurrent glioblastoma multiforme

Abstract: Pathological findings in 20 cases of glioblastoma multiforme were correlated with clinical histories and computerized tomographic (CT) scans. This was done to define the neoplasm in three stages: before treatment, during remission, and during recurrence. The untreated lesions were markedly cellular neoplasms composed predominantly of small anaplastic cells. The radiographic central region of low density was necrosis, the enhancing rim was a cellular zone of viable neoplasm, and the perilesional low-density area was edema with infiltrating tumor. In these 20 cases, all of the identifiable neoplasms lay within the zone of peritumoral edema or contrast enhancement, although small anaplastic cells may have been present in more distant regions. The lesions in remission were remarkable for their minimal mass effect, discrete nature, extensive necrosis, and content of large bizarre glia. The large cells were confined to the original tumor bed and were consistent with neoplastic cells inactivated and immobilized by radio- and chemotherapy. These lesions were accurately localized by CT scanning. The recurrent lesions were heterogeneous, but most were formed of widely disseminated small anaplastic cells. The highly cellular regions of such lesions could be localized by CT scanning, but CT could not detect less cellular foci in the cerebrum, cerebellum, or brain stem. In one patient, the contrast-enhancing lesions of "recurrence," were foci of radionecrosis, underscoring the difficulty in distinguishing this entity from recurrent neoplasm.

Correlations between cytologic composition and biologic behavior in the glioblastoma multiforme. A postmortem study of 50 cases

Abstract: The brains of 50 adults with supratentorial glioblastoma multiforme were studied post mortem. The cytologic compositions of the neoplasms were examined in each of three sites: (1) in and around the original tumor bed; (2) zones of infiltration of contiguous structures; and (3) implants in the subarachnoid and/or ventricular spaces. For this purpose, six different cell types were defined: small anaplastic cells (SAC), small fibrillated cells (SFC), fibrillated astrocytes (FA), pleomorphic astrocytes (PA), gemistocytic astrocytes (GA), and large bizarre cells (LBC). In 16 cases with marked mass effect in the original tumor bed entirely due to the neoplasm, the cytologic composition of the neoplasm was predominantly SAC (14 cases) and SFC (2 cases). The prevalence of these two cellular types was evident in the infiltrated regions in 36 of 42 cases, and in the metastatic foci of 11 of 13 cases. In 10 of 11 cases in which there was mild or no mass effect, only limited infiltration in the ipsilateral hemisphere, and no metastases, the neoplasms were composed of a combination of FA, PA, GA, and LBC. The observations suggest that, in spite of the glioblastoma's cytologic heterogeneity, the pathologic substrate of aggressiveness in this malignant glioma is related largely to the proliferation of a population of small anaplastic cells. On the basis of this observation, as well as the consideration of certain clinical and therapeutic variables, an outline is presented summarizing the history of the glioblastoma multiforme from treatment until the time of death.

Glioblastoma multiforme after radiotherapy for acromegaly

Abstract: A case of glioblastoma multiforme that occurred 14 years after radiotherapy for acromegaly is presented. The striking correspondence between the anatomy of the tumor and the geometry of the radiation ports is suggestive of a causal relationship. Previously reported cases of radiation-associated glioma are reviewed, and a brief appraisal of the evidence for induction of these lesions by radiation is presented. The differentiation of radiation-associated neoplasms from radionecrosis is also discussed.

Choroid plexus carcinoma: Report of a case with lmmunohistochemical and ultrastructural observations

Abstract: A choroid plexus carcinoma from the lateral ventricle of a ten-month-old boy was examined by light and electron microscopy. The neoplasm exhibited papillary and solid areas, invasion of adjacent brain, cytologic anaplasia, and necrosis. Intra- and extracellular PAS positive droplets were present, but no pigment was observed. No glial fibrillary acidic protein was detected within neoplastic cells. Ultrastructural examination revealed irregular nuclei with large nucleoli and occasional intranuclear filamentous rods. Cytoplasmic organelles included a moderate number of free ribosomes, rough endoplasmic reticulum, Golgi complexes, and microtubules. In some areas, numerous mitochondria filled the cytoplasm. Surface specializations included zonulae adherentes, microvilli, and clusters of cilia with a 9 + 0 microtubular pattern. Clusters of basal bodies with prominent basal feet and striated rootlets were present within the cytoplasm. Normal choroid plexus from this patient also had 9 + 0 cilia. In contrast, choroid plexus papillomas from two other infants had cilia with a 9 + 2 pattern. These observations demonstrate that both differentiated and anaplastic choroid plexus neoplasms have the potential to form cilia, and that the microtubular structure of such cilia may deviate from the usual 9 + 2 pattern.

Experience Using Two CT-Guided Stereotactic Biopsy Methods

Abstract: 15 patients had intracranial CT-guided stereotactic biopsies. Biopsies were performed either with a Riechert-Mundinger stereotactic frame modified for use in the CT or by using the CT scan to establis