Morphological and Ultrastructural Findings of Prognostic Impact in Craniopharyngiomas

Abstract

Craniopharyngioma is a slow-growing epithelial tumor with an unpredictable tendency to recur. To verify the reliability in predicting the clinical outcome, some morphological and immunohistochemical findings were analyzed in 37 primitive tumors and in 6 recurrences (one recurred twice). All the tumors were surgically excised and all recurrences exhibited an adamantinomatous pattern; mitotic rate was low (< 5 x 10 HPF) in both recurrent and in nonrecurrent tumors. Primary tumors showed a mean positivity of 1.7% (range 0.3-2%) to PCNA vs. 4.1% (range 0.3-8%) in recurrences. The MIB-1 Labelling Index was: 22.12% in primary tumors, 27.5% in recurrences, 31.3% in adult nonrecurrent tumors, and 4.1% in the pediatric tumor. CD34 labeling vessels/field was 9.3 in primary tumors and 9.91 in the recurrences; VEGF expression was higher in recurrences than in primary tumors (40 vs. 25%). Ultrastructural analysis showed fenestrated endothelium with hydropic changes in VEGF-positive vessels. Lack of clear correlations between morphological or immuno-staining patterns and behavior suggests that these features have no prognostic value in adult as well as in pediatric craniopharyngiomas. In this study, the only results that may be related to the aggressiveness of tumor is the major vascularization in the recurrent tumors in which the vessels show also ultrastructural changes.

Molecular pathology of adamantinomatous craniopharyngioma: review and opportunities for practice

“…2,13,51,[55][56][57] One functional study using a corneal angiogenesis assay revealed that recurrent ACP samples had a significantly higher angiogenic potential than nonrecurrent ACP, but less than glioblastoma multiforme or arteriovenous malformations. 51 Imatinib-loaded microspheres reduced neovascularization in this model, but the use of this or other antiangiogenic approaches in patients has not been reported in the literature.…”

Single and hypofractionated stereotactic radiotherapy with CyberKnife for craniopharyngioma

“…In recent years, several reports have indicated the recurrence of craniopharyngioma may correlate with the angiogenesis [30][31][32]. It is possible that, like endothelial cells, activity of the vascular endothelial growth factor/ vascular endothelial growth factor receptor-2 system and platelet-derived growth factor receptor-alpha in craniopharyngioma may be linked to the increasing permeability of epithelial cells and cyst formation.…”

Prognostic factors of craniopharyngioma with special reference to autocrine/paracrine signaling: underestimated implication of growth hormone receptor

“…However, morphological differences are controversial as a prognostic factor [1], and selection of the area of interest in the pathological specimen is not standardized for such stratified and heterogeneous tissue [10,19]. Sub-classification and more accurate risk evaluation of this tumor are required.…”