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333.Full.Pdf THE AMERICAN JOURNAL OF CANCER A Continuation of The Journal of Cancer Research VOLUMEXXXIV NOVEMBER,1938 NUMBER3 STRUCTURAL DEVELOPMENT IN GLIOMAS H. J. SCHERER, M.D. (Frorn the Dtparlrnent of Pathology, Bzrnge Institute, Antwerp, Belgium) In a morphological study of tumors the purely cytological characteristics, the neoplastic structures formed by the tumor cells, the gross aspects of growth and extension of the tumor, the stages of architectural and cellular development may each be especially considered. Most tumors are classified by their structural characteristics; thus one speaks of adenocarcinoma, scir- rhous carcinoma, alveolar carcinoma, etc. Gliomas, on the contrary, since the work of Bailey and Cushing (2), are classified essentially on the basis of cytologic or even histogenetic characteristics. Recently investigators have become interested in the study of the develop- mental stages of neoplastic structures and the laws regulating their evolution. Ewing (8) has insisted upon the importance of studying “ developmental stages, variations in structures, age, rate of growth and local reactions” in tumors. W. Fischer and his pupils have presented, for the first time, a series of investigations on the laws governing structural development in certain adenocarcinomas (3, 5, 7, 9, 11, 19). For several years we have made a systematic study of the structural evolu- tion of the gliomas (22, 23, 24, 25, 26). This group of tumors, because of the enormous structural variability found even in a single neoplasm, presents a fascinating problem. Our research has had a double purpose: first, to analyze the laws governing structural development in gliomas; second, to attempt the application of these rules of growth to tumors in general. Because gliomas grow in an organ in which the tissue structures are both variable and highly differentiated, they are especially favorable for a study of the influence of preexisting structures on the architectural evolution of the tumor. This is our first attempt to bring together our observations as a whole. At present we are concerned with a description of the structures seen in gliomas and their development both in and of themselves and as they are modified by preexisting tissues. The application of these observations to future classifica- tion of gliomas, the study of the causes of the variations observed in the differ- 333 334 H. J. SCHERER ent gliomas, and the genetic relation between the glial reactions and glioma growth must be the object of further research. MATERIALAND METHODS This work is based upon the microscopic study of 100 gliomas, including the entire tumor and surrounding structures, by means of large celloidin sec- tions taken in many different planes. This method approximates an incom- plete serial section study of the tumor and adjacent tissue. All the gliomas were from autopsy material since we believe it is necessary to examine the entire brain. The celloidin sections were stained by the Nissl, van Gieson and Achucarro methods. Smaller portions of the tumors were examined in both frozen sections and paraffin embedded sections which, in specific instances, FIG. 1. PRECOCIOUS PERISEURAL STRUCTURES FORMINGCAPSULES ABOUT NERVE CELLS. CASE 6/36 NISSL were stained with hemalum-eosin, Mallory, Spielmeyer, Holzer, Bielschowsky, Cajal gold sublimate or scharlach as the occasion demanded. The sections were cut at 20 p to demonstrate clearly the architecture of the tumors. A. SECONDARYSTRUCTURES The term " secondary structures " is used to designate all those structures formed by the cells of the glioma which depend on the preexisting tissue ele- ments. These structural characteristics may be recognized even after com- plete destruction of the tissue elements by the tumor cells. Some of the secondary structures resemble in localization and form corresponding reactive formations. (1) Perineural and Ncuronophagic Growth: It is frequently observed that, as a glioma begins to invade the cortex or other mass of gray substance, the first manifestation of the neoplastic process is a collection of glioma cells about all or a great many of the nerve cells (Figs. 1 and 2). This we call perineural growth. Sometimes the neoplastic cells may be seen for a con- STRUCTURAL DEVELOPMENT IN CLIOMAS 335 siderable distance along the dendrites, particularly the apical dendrites of the pyramidal cells of the cortex. This picture may occur in a cortex otherwise relatively free of glioma cells (" precocious perineural growth," see Scherer, 24) or in a cortex already heavily infiltrated with tumor cells (" late perineural growth "). These cells are identical with the other tumor cells found in the region (Figs. 1, 2 and 3) and this, plus the great regularity of the phenomenon, easily distinguishes the process from a " satellitosis " or reactive neurono- phagia. If the collection of tumor cells replaces the nerve cells after their destruc- tion, we speak of the process as neuronophagic growth. In this case the groups of tumor cells may closely resemble the nerve cells in form and dis- tribution. This may occur in the isocortex and allocortex, in the brain stem, thalamus, and corpus striatum, as well as at other levels. In areas having a FIG. 2. PRECOCIOUSPERIXEITRAL STRUCTURES FORMED BY MONSTROUSGLIOMATOUS CELLS REPL4rING TIIE Nt,itVE Ck1.I.S AND THEIRDEHnRITES. CASE 128/35. NISSL characteristic architectural pattern, such as the cortex, or the corpus striaturn the resemblance of the collections of the glioma cells to the normal architecture is striking (Fig. 4). This phenomenon has been observed as an occasional process in isolated cases by Storch (28), Landau (13), Stumpf (30), Ranke (18), Bielschowsky (4) and von Santha (2 1 ) , but was first described as a frequent form of glioma growth by Scherer in 1936 (24). (2) Surface Growth: Surface growth, first described by Storch in 1899 (28), consists in a more or less thick layer of gliomatous cells in the molecular layer of the cortex (Fig. 9) above a glioma of the white matter which does not involve the cortex generally. We have observed this phenomenon rarely on the internal surface of the brain, in the form of an extensive subependymal growth. This secondary structure corresponds to reactional surface gliosis but, like other secondary growths, is differentiated by the neoplastic character 3 36 H. J. SCEIERER of the cells. These glial borders, at first very thin, become progressively thicker and remain recognizable by their greater cellular density even after the whole cortex is markedly invaded by the glioma. (3) Perivascular Growth: In this mode of development, first described by Scherer (1937) as a frequent form of early growth, there is an arrangement FIG. 3. LATEPERISEUR.\L ASD PERIVASCULAR STRL-CTURES IN A COKrEX ALREADYC0MPI.ETEI.Y ISVADEDHY THE TUMOR.CASE 150/35. NWL of the glioma cells outside the Virchow-Robin spaces (Figs. 3 and 4) about many of the preexisting vessels in a situation corresponding to a reactive peri- vascular gliosis. It may be differentiated from a true perivascular gliosis by the character of the cells, the regularity of the process, the predilection for small vessels of capillary and precapillary size, the sharply limited external borders and, in many cases, by the tendency to develop concentrically ar- ranged layers of cells (Fig. 3). Like the perineural growth, the perivascular growth may be seen at some distance from the compact tumor in areas other- wise totally free of tumor cells (precocious form). On the other hand, this characteristic structure may persist after the tumor cells are already fairly dense (Fig. 3). This phenomenon is much more frequent in the cortex and in the corpus striatum than in the white substance. The cellular nature of the perivascular cuffs varies with the cellular character of the rest of the tumor. (41 Pcrijasciczilar Grouith: Perifascicular growth is in accord with the observation of Strobe (29) that “ the gliomatous growth follows the paths of the preexisting nerves.” It is much less frequently seen, however, than was formerly supposed. It is observed most frequently in the deep portions of the centrum ovale at the interdigitation of radiations of the corpus callosum and the internal capsule, in the internal capsule itself, and in the cerebral peduncle. The tumor cells occupy the interfascicular spaces, following the STRUCTURAL DEVELOPMENT IN GLIOMAS 337 surface of the thick nerve bundles, without invading the bundles themselves. The resulting picture resembles a network made up of elongated, round, or ovoid links depending on the direction in which the section is cut (Fig. 5). (5) Zntrafascicular Growth: Growth within the bundles of nerve fibers, leaving intact their distribution, direction, and decussations (Fig. 6), was first FIG. 4. PRECOrlOUS PLRIVAS(.ULAR 4ND PtRlStUR,\L STRUCTURES lh' TIlE PUTAMEN, IMITATISC PERFECTLYTIIE NORMALAHWITLCTURE OF THE CORPL~SSTRIATUM. CASE 204/35. NISSL FIG.5. TYPICALPLRIFASTICULAR STRZK TLTRES, CUT TRASSVERSELY.CASE 75/35. NISSL described by Scherer (25) in 1936. The picture thus produced resembles " central neurinoma '' or spongioblastoma unipolare (Cox, 6). We believe this type of growth to be a simple secondary structure which is rather infre- quently seen, but may occur under favorable conditions in entirely different cytological types of glionia. Once developed, it maintains its characteristic 338 H. J. SCHERER FIG. 6. INTRAFASCIC171.AR GROwlH IN A GLIOBLASTOMA MULTIPORMEGAXCLIOIDES IN THE ISTERNAL CAPS1TI.E. CASE 64/37. NISSL The tumor imitates perfectly the normal fasciculation and stops exactly at the border of the caudate nucleus (above). Under the higher magnification (below) the cells are seen to have as- sumed an elongated form. appearance even when the area has become densely invaded by tumor cells (Fig. 6). It occurs most frequently in spongioblastoma multiforme and the most beautiful examples are seen in the internal capsule, corona radiata. (6) Zrrterfibrillary Growth: Essentially the same as intrafascicular growth, interfibrillary growth is quite different in appearance, consisting of long col- STRUCTURAL DEVELOPMENT IN GLIOMAS 339 FIG. 7. I’YPICAL INTERFIBRILLARY GROWTII,IN THE INTERNAL CAPSULE.
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