Sixty-seven tumor specimens of epithelial choroid plexus neoplasms obtained by 60 biopsies and 7 autopsies from 52 patients were investigated. Diagnoses of the first operations were choroid plexus papilloma (PP; 32 cases), choroid plexus papilloma with histological atypies (atypical PP; 6 cases), and choroid plexus carcinoma (PC; 14 cases). Carcinoembryonic antigen was expressed by 2 of the 3 biopsies autoptically recognized as metastatic carcinomas and by 2 autopsy cases of PC, while it was absent in all biopsies of true choroid plexus tumors. Tumor cells positive for transthyretin (TTR, prealbumin), S-100 protein (S100), and glial fibrillary acidic protein (GFAP) were detected in 39, 46 and 13, respectively, of the 49 cases of true choroid plexus tumors. Fourth ventricle tumors expressed more S100 (number of positive tumor cells) than lateral ventricle tumors, PP more S100 and TTR than atypical PP/PC. Tumors from patients 20 years of age and older expressed more GFAP and TTR than tumors from younger patients. Of the 30 patients with complete follow-up 19 were alive 2 to 11 years after surgery, including 7 recurrencies. Eleven died from the tumor 4 months to 7 years after surgery. The following histopathologic features (in order of decreasing significance) were correlated with poor prognosis (recurrency or fatal outcome): less than 50% of the tumor cells heavily positive for S100, presence of mitoses, absence of TTR-positive cells, brain invasion by cell nests, absence of marked stromal edema, and presence of necrotic areas. Our results indicate that some histologic features correlate significantly with poor prognosis and that immunohistochemical results correlate with tumor localization, age, and malignancy.

The collagen matrix is an effective and safe cranial and spinal dural substitute that can be used even in cases of an existing local infection. Postoperative deep infection increases the risk for CSF leakage.

SUMMARY The presence of a pregnancy at the time of the initial diagnosis of an intracranial neoplasm was studied using material from a population-based tumour registry. Seventeen malignant neoplasms of the brain (ICD 191), three meningiomas, three acoustic neurinomas and a pituitary adenoma associated with pregnancy were reported to the National Cancer Registry of the GDR from [1961][1962][1963][1964][1965][1966][1967][1968][1969][1970][1971][1972][1973][1974][1975][1976][1977][1978][1979]. Observed cases were compared with those expected based on the number of births and the incidence rates for intracranial tumours among women of childbearing age during the same time period. Observed to expected ratios were substantially reduced for malignancy of the brain and meningioma but not for acoustic neurinoma. Review of this uniformly collected material did not provide support for the view that intracranial neoplasms present more often during pregnancy.The diagnosis of a brain tumour in a pregnant patient is a dramatic event for the patient, her family and for the attending physicians. The nature and timing of therapy directed at the brain tumour are affected by the existence of the pregnancy. Similarly, decisions about whether to continue the pregnancy and the selection of the best means of delivery are critically influenced by the nature and prognosis of the mother's intracranial lesion. In addition the question of a causal link between pregnancy and the development or progression of the tumour is inevitably raised. The present work approached the problem of the association of brain tumour with pregnancy from the epidemiologic point of view.The literature concerning pregnancy and intracranial neoplasms consists largely of case reports, case series and reviews of previously collected material.' Cases may have come from one or several referral centres and, in some instances, have been collected over decades.2 Different definitions are used by each author in the selection and review of cases. Depending on the criteria, patients may be included in whom brain tumour symptoms or diagnosis occurred before, during or after pregnancy. Given such diverse methods of case selection, the assessAddress for reprint requests: Prof. Dr W Janisch,

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