Clinicopathological Study of Diffuse Type Brainstem Gliomas: Analysis of 40 Autopsy Cases

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Diffuse type brainstem gliomas, one of the most malignant brain tumors, have an extremely poor prognosis. Accordingly, it is presumed that the proliferative potential of these tumors is very high, but to date there have been few reports about the cell kinetics of the brainstem gliomas because surgical resection of these tumors has been applied only in limited cases. Forty autopsy cases with diffuse type brainstem gliomas were evaluated for histological grading, tumor spread, growth potential and prognosis. To quantify the growth potentials of individual tumors, we use monoclonal antibodies MIB-1 and proliferating cell nuclear antigen (PCNA), and proliferating cell indices (PCIs) were examined. In 34 glioblastomas (GMs), mean MIB-1 and PCNA proliferating cell indices (PCIs) were 20.4% and 37.0%, respectively. Their median survival time in 22 treated cases was 40 weeks. In 5 anaplastic astrocytomas (AAs), mean PCNA PCIs was 10.8% and their median survival time in 4 treated cases was 91 weeks. The MIB-1 and PCNA PCIs of one astrocytoma (A) were 2.9% and 20.3%, respectively, and the survival time was 56 weeks. There was a significant difference in PCNA PCIs between GMs and AAs (p<0.05), and there was also a significant difference in survival time between GMs and AAs, A in treated cases (p<0.05). Supratentorial extension was more frequent in GMs than in AAs (p<0.05). Our results suggest that the majority of diffuse type brainstem gliomas are GM and their proliferative potentials are probably as high as that of adult supratentorial glioblastoma. Furthermore, supratentorial extension and dissemination are relatively frequent. There are a few AA or A, and they are less infiltrative and proliferative and have a slightly better prognosis than GM.

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