Cerebellar capillary hemangioblastoma: its histogenesis studied by organ culture and electron microscopy

Establishment and Characterization of Cell Lines from Primary Culture of Hemangioblastoma Stromal Cells

Context

A well-established cell line of hemangioblastomas (HBs) is still lacking.

Aim

This study aims to explore a stable way to establish primary cell lines of HB stromal cells and investigate the morphological and molecular features of these cells.

Patients and Methods

Specimens of HBs from 13 patients were collected for establishment of primary cell lines of stromal cells. The details on cell culture were described, and the characterizations of cultured cells were conducted by morphological observation, immunocytochemical staining of inhibin-α, brachyury, CD133, CD34, GFAP, CD31, NeuN, CD45, Oligo2, and transmission electron microscopy.

Results

Eleven cases were successfully cultured with a success rate of 84.6%. The cultured cells survived for 10 generations with an estimated doubling time of 77.2 ± 5.89 h. Light microscopy revealed that these cells showed vigorous growth status and presented as polygons or trigons with significant heterogeneity. The immunocytochemical staining showed that inhibin-α, brachyury, CD133, and CD34 were expressed in all the cultured cells, whereas the expression of GFAP, CD31, NeuN, CD45, and Oligo2 was all negative. Transmission electron microscopy confirmed that the cultured cells were stromal cells with typical lipid droplets. The phenomenon of lysosomal autophagy was commonly observed without apoptotic cells in late stage.

Conclusion

Appropriate selection of tumor specimens, short duration of devascularization, ideal digestion time, and nutritious medium are critical points for establishment of primary cell line of HB stromal cells. Stromal cells from both von Hippel-Lindau disease-related HBs and sporadic HBs might originate from embryologically arrested hemangioblasts.

Fatty-acid-induced FABP5/HIF-1 reprograms lipid metabolism and enhances the proliferation of liver cancer cells

Hypoxia-inducible factor-1 alpha (HIF-1α) is a transcription factor essential for cancer cell survival. The reprogramming of lipid metabolism has emerged as a hallmark of cancer, yet the relevance of HIF-1α to this process remains elusive. In this study, we profile HIF-1α-interacting proteins using proteomics analysis and identify fatty acid-binding protein 5 (FABP5) as a critical HIF-1α-binding partner. In hepatocellular carcinoma (HCC) tissues, both FABP5 and HIF-1α are upregulated, and their expression levels are associated with poor prognosis. FABP5 enhances HIF-1α activity by promoting HIF-1α synthesis while disrupting FIH/HIF-1α interaction at the same time. Oleic-acid treatment activates the FABP5/HIF-1α axis, thereby promoting lipid accumulation and cell proliferation in HCC cells. Our results indicate that fatty-acid-induced FABP5 upregulation drives HCC progression through HIF-1-driven lipid metabolism reprogramming.

Seo et al. identify fatty acid-binding protein 5 (FABP5) as a booster of HIF-1α activity. They find that oleic-acid treatment activates the FABP5/HIF-1α axis, promoting lipid accumulation and cell proliferation in liver cancer cells. This study provides insights into how fatty acids drive the progression of cancer.

Lipid Droplets in Cancer: Guardians of Fat in a Stressful World

Cancer cells possess remarkable abilities to adapt to adverse environmental conditions. Their survival during severe nutrient and oxidative stress depends on their capacity to acquire extracellular lipids and the plasticity of their mechanisms for intracellular lipid synthesis, mobilisation, and recycling. Lipid droplets, cytosolic fat storage organelles present in most cells from yeast to men, are emerging as major regulators of lipid metabolism, trafficking, and signalling in various cells and tissues exposed to stress. Their biogenesis is induced by nutrient and oxidative stress and they accumulate in various cancers. Lipid droplets act as switches that coordinate lipid trafficking and consumption for different purposes in the cell, such as energy production, protection against oxidative stress or membrane biogenesis during rapid cell growth. They sequester toxic lipids, such as fatty acids, cholesterol and ceramides, thereby preventing lipotoxic cell damage and engage in a complex relationship with autophagy. Here, we focus on the emerging mechanisms of stress-induced lipid droplet biogenesis; their roles during nutrient, lipotoxic, and oxidative stress; and the relationship between lipid droplets and autophagy. The recently discovered principles of lipid droplet biology can improve our understanding of the mechanisms that govern cancer cell adaptability and resilience to stress.

Stromal cells of hemangioblastomas exhibit mesenchymal stem cell-derived vascular progenitor cell properties

Hemangioblastoma is composed of neoplastic stromal cells and a prominent capillary network. To date, the identity of stromal cells remains unclear. Mesenchymal stem cells can give rise to committed vascular progenitor cells, and ephrin-B2/EphB4 and Notch signaling have crucial roles in these steps. The aim of our study was to elucidate that stromal cells of central nervous system hemangioblastomas have mesenchymal stem cell-derived vascular progenitor cell properties. Ten hemangioblastomas were investigated immunohistochemically. CD44, a mesenchymal stem cell marker, was detected in stromal cells of all cases, suggesting that stromal cells have mesenchymal stem cell-like properties. Neither CD31 nor α-SMA was expressed in stromal cells, suggesting that stromal cells have not acquired differentiated vascular cell properties. Both ephrin-B2 and EphB4, immature vascular cell markers, were detected in stromal cells of all cases. Jagged1, Notch1, and Hesr2/Hey2, which are known to be detected in both immature endothelial cells and mural cells, were expressed in stromal cells of all cases. Notch3, which is known to be detected in differentiating mural cells, was also expressed in all cases. These results suggest that stromal cells also have vascular progenitor cell properties. In conclusion, stromal cells of hemangioblastomas exhibit mesenchymal stem cell-derived vascular progenitor cell properties.

Pathology of the Nervous System in Von Hippel-Lindau Disease

Von Hippel-Lindau (VHL) disease is a tumor syndrome that frequently involves the central nervous system (CNS). It is caused by germline mutation of the VHL gene. Subsequent VHL inactivation in selected cells is followed by numerous well-characterized molecular consequences, in particular, activation and stabilization of hypoxia-inducible factors HIF1 and HIF2. The link between VHL gene inactivation and tumorigenesis remains poorly understood. Hemangioblastomas are the most common manifestation in the CNS; however, CNS invasion by VHL disease-associated endolymphatic sac tumors or metastatic renal cancer also occur, and their differentiation from primary hemangioblastoma may be challenging. Finally, in this review, we present recent morphologic insights on the developmental concept of VHL tumorigenesis which is best explained by pathologic persistence of temporary embryonic progenitor cells.

VHL-deficient vasculogenesis in hemangioblastoma

Hemangioblasts are capable of differentiation into vascular structures and blood. Patients with von Hippel-Lindau (VHL) disease develop hemangioblastomas which are composed of VHL-deficient tumor cells with protracted hemangioblastic differentiation potential. In a subset of these tumors, hemangioblastic differentiation is characterized by different stages of red blood cell formation. It has remained controversial, however, whether VHL-deficient hemangioblastic cells are similarly capable of differentiating into vascular cells and functioning vascular structures in vivo. By histologic, immunohistologic and microdissection-based genetic analysis of 60 VHL disease-associated hemangioblastomas, we re-examined the controversial question whether VHL-deficient neoplastic hemangioblastic cells are capable of vascular differentiation (vasculogenesis). In most tumors (n=47), there was no evidence of either vasculogenesis or hematopoiesis; tumor cells were either scattered between reactive angiogenetic vascular structures or arranged in solid clusters. A subset of tumors (n=13), however, revealed vaculogenetic structures that were composed of cuboidal or flat cells and frequently contained red blood cell precursors or mature red blood cells. Microdissection-based deletion analysis of epithelial cells confirmed them to be VHL-deficient tumor cells. Immunohistochemistry for CD31 was consistently negative in these structures, and no evidence could be obtained for connectivity with reactive vasculature. We demonstrate that hemangioblastic differentiation capacity of VHL-deficient hemangioblastic cells includes not only erythropoiesis, but also differentiation into primitive vasculogenetic structures. Tumor cells, however, do not appear to have the potential of terminal differentiation into mature and functional vascular structures.

Lipidized glioblastoma: pathological and molecular characteristics

We report a rare case of a 33-year-old man with a lipidized glioblastoma multiforme (GBM) in the right posterior frontal region. Histologically the tumor had all the typical features of a GBM but with the rare observation of lipidized differentiation. There were multiple mitoses, extensive vascular proliferation, focal necrosis and the tumor cells had abundant xanthomatous cytoplasm and marked nuclear pleomorphism. The tumor showed immunoreactivity with GFAP. The O(6) - methylguanine methyltransferase (MGMT) promoter was methylated and there were no isocitrate dehydrogenase (IDH)1 and IDH2 mutations. To the best of our knowledge, this is the first time MGMT promoter status and IDH mutation assessment have been reported in a case of lipidized GBM.

Hemangioblastomas share protein expression with embryonal hemangioblast progenitor cell

Hemangioblastomas are central nervous system (CNS) tumors of unknown histogenesis, which can occur sporadically or in von Hippel-Lindau disease. Hemangioblastomas are composed of neoplastic "stromal" cells of unknown origin, accompanied by intensive reactive angiogenesis. Failure to specify the cytologic origin of the stromal cell has precluded the development of nonsurgical therapies and limits understanding of its basic biology. We report that the stromal cells express proteins (Scl, brachyury, Csf-1R, Gata-1, Flk-1, and Tie-2) that characterize embryonic progenitor cells with hemangioblastic differentiation potential and conclude that embryonic progenitors with hemangioblast potential represent a possible cytologic equivalent of the stromal cell. We also identified a new autocrine/paracrine stimulatory loop between the receptor Tie-2 and the hypoxia-inducible factor target Ang-1, which, combined with previous observations, suggests that a variety of autocrine loops may be initiated in hemangioblastomas, depending on the differentiation status of the tumor cells and the extent of HIF downstream activation. Finally, the consistent identification of Scl in the stromal cells may help explain the unique and characteristic topographical distribution of hemangioblastomas within the CNS.

Stromal cells in hemangioblastoma: neuroectodermal differentiation and morphological similarities to ependymoma

The histogenesis of stromal cells in hemangioblastoma is inconclusive despite a long-term controversy. An immunohistochemical and ultrastructural study was conducted for 17 cases of cerebellar hemangioblastoma. A wide range of immunohistological markers, targeting epithelial, mesenchymal, endothelial and neuroectodermal tissues, was used. In all cases, the microscopic hallmark characterizing hemangioblastomas, that is, lipid-containing stromal cells and a fine capillary network, known as a reticular variant, was noted. Stromal cells showed a variable immunoreactivity for neuroectodermal markers, such as S-100 protein, CD56, CD57, CD99, and neuron-specific enolase. This result, in conjunction with the absence of immunoreactivity for epithelial, mesenchymal, and endothelial markers, likely suggests neuroectodermal differentiation of stromal cells. In three cases, another component, known as a cellular variant, where epithelioid tumor cells were arranged in nests encircled by capillaries and/or in pseudorosette-like structures, was noted. Glial fibrillary acidic protein-immunoreactivity, which was totally absent in cases only showing the reticular pattern, was noted in two of them, suggesting a distinctive sign of glial differentiation in a proportion of hemangioblastomas. Ultrastructurally, microvilli-like projections in intracytoplasmic vacuoles were demonstrated in stromal cells. This result, taken together with the neuroectodermal hypothesis of stromal cells, suggests that hemangioblastomas may occasionally exhibit morphological similarities to ependymomas.

Hemangioblastomatosis of the central nervous system without von Hippel–Lindau Disease: a case report

We report a very rare case of hemangioblastomatosis in a patient without von Hippel-Lindau disease (VHL). A 50-year-old woman had a history of surgical procedures for total removal of a cerebellar hemangioblastoma (HB). Twenty-one years after the last operation, she developed communicating hydrocephalus; computed tomographic (CT) scans of the brain showed no recurrence of HB in the posterior fossa. Subsequently, she underwent placement of a ventriculo-peritoneal shunt. One year later, she was readmitted because of progressive numbness and pain in the left lower limb. Magnetic resonance imaging (MRI) showed multiple Gd-enhancing tumors around the brain stem, in the cerebellum, and in the cervical and thoracolumbar regions of the spine. She underwent surgical removal of the tumors in the cerebellum and spinal cord. Although the extirpated tissues were histopathologically verified HB with less than 1% MIB-1 labeling index, surgery was followed by external beam radiation therapy with doses of 40 Gy to the whole brain, 10 Gy to the posterior fossa and 30 Gy to the whole spine. However, she subsequently developed quadriparesis and became bedridden.

Lucien J. Rubinstein: enduring contributions to neuro-oncology

Dr. Lucien Rubinstein is best remembered for his significant contributions to the field of neuropathology, particularly in the classification of nervous system tumors. His accomplishments in basic neuro-oncology and in the formulation of diagnostic principles reflected a unique talent for synthesizing fundamental clinicopathological concepts based on skillful diagnostic investigation and a thorough understanding of neurobiology. Dr. Rubinstein was the leader in the establishment of cell cultures from central nervous system (CNS) tumors. He meticulously analyzed both light and electron microscopic features of CNS tumors, recorded his findings, and patiently drew sketches to be shared generously with his colleagues and students. As a pioneer in neuropathology, in his work Dr. Rubinstein set the foundation for many enduring concepts in neurosurgery, neuro-oncology, neurology, and basic tumor biology.

Developmental effects of von Hippel-Lindau gene deficiency

The histogenetic origin and the basis of the distribution of central nervous system (CNS) hemangioblastomas in the von Hippel-Lindau (VHL) tumor suppressor gene syndrome, VHL disease, are unknown. To better understand hemangioblastoma histogenesis, we analyzed postmortem CNS tissues from four patients with well-established diagnosis of VHL disease including development of characteristic tumors and positive family history. Numerous angiomesenchymal tumorlets, which resembled hemangioblastoma, but which also consistently showed distinct histological features, were distributed in the nerve roots, spinal cord, and cerebellum. Genetic analysis consistently showed deletion of the wild-type VHL allele in these tumorlets. Most angiomesenchymal tumorlets were in the dorsal nerve roots; the anterior roots and cerebellum were less frequently affected. Tumorlet distribution was highly consistent in the four cases. In analogy to the wide morphological spectrum of lesions known to exist in VHL kidneys, nerve roots appear to harbor more wide-spread and morphologically heterogeneous changes than previously appreciated. The abundance of tumorlets, associated with highly consistent morphology and topography, suggests a developmental origin of hemangioblastoma. Therefore, in VHL disease, inactivation of the VHL wild-type allele appears necessary, but not sufficient, for the formation of tumor that produces symptoms and neurological disability.

Transthyretin and transferrin in hemangioblastoma stromal cells

Hemangioblastoma, a rare benign tumor of the CNS, consists of two main components: capillaries and stromal cells. Despite many efforts, the histogenesis of stromal cells is still unknown. We took a new approach to clarify the origin of stromal cells using immunohistochemical methods. Paraffin-embedded tissue of 24 surgically removed hemangioblastomas of the CNS was examined with antibodies against transthyretin, transferrin, vimentin, NSE, protein S-100, CK 8, KL-1, EMA, CD34, factor VIII rAg, and collagen IV. Stromal cells showed a positive reaction with anti-transthyretin in 12 of 24 hemangioblastomas, a positive reaction with anti-transferrrin, to a different extent, in 13 of 24 cases, and many stromal cells expressed basal membrane collagen IV on the cell surface in 19 of 24 cases. The expression of transthyretin and transferrin in stromal cells of hemangioblastomas is reported for the first time, thus providing an antigenic profile of hemangioblastoma stromal cells that is very similar to that of immature choroid plexus epithelium. These findings support the notion that hemangioblastoma stromal cells may originate from the embryonal plexus epithelium. We discuss our results with special regard to stromal cell histogenesis, including a review of the literature.

VEGF in brain tumors

Vascular endothelial growth factor (VEGF) is a regulator of angiogenesis, vasculogenesis and vascular permeability. In this contribution, molecular and biological properties of VEGF are described. Furthermore, this article focuses on the evidence that angiogenesis in brain tumors is mediated by VEGF. Among the topics discussed are expression patterns of VEGF and its receptors in different brain tumors, possible regulatory mechanism involved in the VEGF-driven tumor angiogenesis and the involvement of VEGF in the genesis of peritumoral edema. Finally, anti-angiogenesis approaches to target VEGF/VEGF receptors are discussed.

Angiogenic histogenesis of stromal cells in hemangioblastoma: ultrastructural and immunohistochemical study

Controversy regarding the origin of characteristic stromal cells (SC) is responsible for the placement of hemangioblastoma as a single entity in the category of "tumors of uncertain histogenesis" in the current WHO classification of brain tumors. This subclassification of hemangioblastoma is, to a large extent, a consequence of a remarkable antigenic heterogeneity of SC demonstrated in many, often contradictory immunohistochemical studies. In contrast, most of the electron microscopic studies demonstrated a number of features indicating angiogenic nature of SC and, therefore, hemangioblastoma. This study reevaluated the histogenesis of SC, applying immunohistochemistry as well as electron microscopy and immunoelectron microscopy. Immunohistochemical studies confirmed most of the previous results indicating a very frequent expression of vimentin, S-100 protein, neuron-specific enolase, and cytokeratins. SC were less commonly immunoreactive for desmin, factor XIIIa, and Ricinus communis lectin receptors, and only occasionally for factor VIII and Ulex europeus lectin. They were negative for other markers of endothelial, neuronal, glial, neuroendocrine, and smooth muscle differentiation. Approximately 1% of SC showed Ki67 immunoreactivity, indicating their slight proliferative activity, consistent with the benign nature of the tumor. In contrast to the inconclusive results of the immunohistochemistry, electron microscopy demonstrated a clear relationship of SC to endothelial cells, smooth muscle cells, and pericytes. Occasional SC were found within the vascular lumina. SC often showed intracellular caveolae consistent with the formation of early capillary lumina. Moreover, occasional SC contained small Weibel-Palade bodies positive for factor VIII in immunoelectron microscopy. SC represent a heterogeneous population of abnormally differentiating mesenchymal cells of angiogenic lineage, with some morphological features of endothelium, pericytes, and smooth muscle cells. Occurrence of SC in hemangioblastoma could be related to a limited ability of angioformative stromal cells to develop an architecture of capillary lumina integrated with the vascular network of the tumor. Hemangioblastoma should be reclassified and included together with other vascular tumors of the central nervous system.

von Hippel-Lindau gene deletion detected in the stromal cell component of a cerebellar hemangioblastoma associated with von Hippel-Lindau disease

Central nervous system hemangioblastoma is a neoplasm with characteristic and well-described histopathological features, including proliferation of vascular and stromal cells. yet, the histogenesis of the stromal cell component and its neoplastic capacity as compared with the vascular component are still controversial. Stromal cells were selectively procured from formalin-fixed, paraffin-embedded archival tissue from a von Hippel-Lindau (VHL) disease patient with a cerebellar hemangioblastoma and studied for loss of heterozygosity (LOH) of the VHL gene locus and associated microsatellite regions. The stromal cells consistently showed LOH. Analysis of mixed stromal anti vascular areas of this tumor and four other hemangioblastomas of VHL patients showed that loss of heterozygosity was partially obscured. These preliminary results suggest that the stromal component of hemangioblastomas contains genetic alterations consistent with a neoplastic nature. Additional samples of pure stromal cells need to be analyzed to establish the prevalence of VHL gene deletion in stromal cells of capillary hemangioblastoma and, hence, its pathogenetic significance.

Fibrohistiocytic differentiation in capillary hemangioblastoma

Seven cases of capillary hemangioblastoma from the cerebellum and spinal cord were studied by immunohistochemical methods to determine the origin of the stromal cells. A subpopulation of factor XIIIa-positive tumor cells was a constant feature in hemangioblastomas. These stellate or spindle-shaped cells transformed into typical vacuolated stromal cells. Factor VIII-related antigen was limited to the vascular endothelium. Glial fibrillary acidic protein was present only in entrapped astrocytes. Staining for alpha-1-antitrypsin (alpha 1AT) and alpha-1-antichymotrypsin (alpha 1 ACT) was occasionally observed in stromal cells. It was concluded that the factor XIIIa-positive stromal cells in capillary hemangioblastoma indicate fibrohistiocytic differentiation, which is part of the differentiation spectrum of hemangiopericytomas.

The growth of two murine hemangioendotheliomas intracranially, subcutaneously, and in culture, and their comparison with human cerebellar hemangioblastomas: morphological and immunohistochemical studies

Two thorium dioxide-induced murine hemangioendotheliomas, 42021 TCT and 44347 TST, were grown subcutaneously (for up to 22 and 15 passages respectively) or intracranially (single passage) and were adapted to culture as a monolayer and, in a limited fashion, in an organ culture system or in rotary suspension. They remained viable and malignant following 20-21 years of storage in liquid nitrogen, and had ultrastructural similarities to human hemangioblastomas. The murine tumors were positive for Griffonia (Bandeiraea) simplicifolia isolectin B4 binding, establishing their endothelial nature; however, unlike human hemangioblastic tumors, they did not cross-react with antisera to human factor VIII or fibronectin and they did not demonstrate Ulex europaeus type I lectin (UEA I) binding (as is also the case for non-neoplastic murine vascular endothelial cells). A variety of morphological cell types in cultures derived from the tumors were also positive for Griffonia (Bandeiraea) simplicifolia isolectin B4 binding. Both murine hemangioendotheliomas, when implanted in the cerebrum, were potent inducers of reactive gliosis, but there was no evidence of uptake of glial fibrillary acidic protein. Unlike the human cerebellar hemangioblastomas, murine tumors were malignant and invasive and did not contain stromal cells, nor did they demonstrate Weibel-Palade bodies or extensive pinocytotic activity. Thus, the murine tumors appear to more closely resemble angiosarcomas or epitheloid hemangioblastomas than the cerebellar hemangioblastomas.

Coexistent hemangioblastoma and arteriovenous malformation of the cerebellum. Case report

A case of cerebellar hemangioblastoma and coexistent arteriovenous malformation (AVM) is presented. Angiography displayed the AVM, but histological examination revealed a coexisting hemangioblastoma. Various theories concerning the etiology of this condition are discussed.

Desmoplastic cerebral astrocytoma of infancy. Light microscopy, immunocytochemistry, and ultrastructure

The first detailed ultrastructural study of a superficial desmoplastic cerebral astrocytoma of infancy is reported. This is a neoplasm which mimics a mesenchymal tumor, originally described in 1984 under the name of "superficial cerebral astrocytoma attached to dura." This tumor, which is believed to have a good prognosis, was resected from the frontoparietal region of a 6.5-month-old girl, in whom it had presented as a large densely enhancing vascular and cystic mass. The ultrastructure of the tumor appeared to be distinctive, characterized by the absence of neuronal elements, and the presence of large amounts of redundant and sometimes extensively duplicated basal laminal material and collagen between nonpleomorphic and nonlipidized astrocytes, corresponding to the reticulin fibers seen by light microscopic analysis between the S-100 protein and glial fibrillary acidic protein (GFAP)-positive cells. The features of the tumor, its differential diagnosis, and its relationship to other pediatric supratentorial tumors are discussed.

Histogenesis of intracranial haemangiopericytoma and haemangioblastoma. An immunohistochemical study

An immunohistochemical study was performed on three meningeal haemangiopericytomas and four cerebellar haemangioblastomas (paraffin embedded) in an attempt to elucidate the uncertain histogenesis of these tumours. The tumour cells of all meningeal haemangiopericytomas show no expression of alpha-smooth muscle actin and, thus, no immunohistochemical proof of their true pericytic nature can be obtained. The stromal cells of cerebellar haemangioblastomas show foci of positive staining for S-100 protein, neuron-specific enolase and synaptophysin, thereby clearly indicating their neuroectodermal origin. These results allow the conclusion that the present nomenclature of these tumours is at least arguable and probably incorrect.

Distribution of collagen type IV in brain tumors: an immunohistochemical study

One hundred-twenty seven human brain tumors were examined by an immunoperoxidase technique for the expression of collagen Type IV, a major constituent of basement membrane. The parenchymal components were negative for the marker protein in all tumors except for neurilemmomas which were positively stained. In every case, the antibody to collagen Type IV showed distinct staining of the vascular pattern. In gliomas, capillaries increased in number and the vascular staining increased in intensity. Fine branching capillaries and endothelial glomeruloid proliferations characteristic each of oligodendrogliomas and glioblastomas could be distinctly illustrated. In two ependymomas, marked capillary proliferation was noted in periventricular areas. Fibrillar staining was observed between the tumor cells in seven of 34 meningiomas. Pericapillary lamellar deposition of collagen Type IV suggests a vascular origin of psammoma bodies. In some malignant tumors, pial-glial membranes were disrupted and the Virchow-Robin spaces were filled with malignant cells. Collagen Type IV was absent around the stromal cells of hemangioblastomas, suggesting that these stromal cells were unrelated histogenetically with endothelial cells. Collage Type IV may be useful in the differential diagnosis between meningiomas and neurilemmomas.

Stromal cells in cerebellar haemangioblastomas: an immunocytochemical study

The nature of the stromal cells in formalin-fixed paraffin-embedded material from 23 cerebellar haemangioblastomas was investigated using antisera to intermediate filaments (glial fibrillary acidic protein, vimentin and desmin), histiocytic markers (alpha 1-antitrypsin, alpha 1-antichymotrypsin and lysozyme), glycolytic enzymes (alpha and gamma enolase and aldolase C4) and the endothelial markers, factor VIII related antigen and Ulex europaeus I lectin. Most stromal cells stained positively for vimentin and the glycolytic enzymes. Occasional process-bearing cells within the stroma stained strongly for glial fibrillary acidic protein, alpha 1-antitrypsin and alpha 1-antichymotrypsin. No stromal cell staining for desmin, lysozyme or the endothelial markers was observed, although the latter stained the vascular endothelium within all neoplasms. The findings do not support previous suggestions of an endothelial or histiocytic origin for the stromal cells. They appear to be a heterogeneous population including entrapped reactive astrocytes and locally-derived non-angiogenic cells of neuroectodermal (pial) origin.

Erythropoietin in capillary hemangioblastoma. An immunohistochemical study

Capillary hemangioblastoma is a tumor known to be associated with secondary polycythemia. Therefore, specimens from ten hemangioblastomas were studied by immunohistochemistry for the presence of erythropoietin, renin substrate, and for various endothelial, histiocytic and glial markers. In all tumors scattered cells among the stromal cells showed a positive-staining reaction with both anti-erythropoietin and anti-renin substrate. The same cells also stained positively for alpha-1-anti-trypsin. It is concluded that, in addition to the capillary endothelial cells, pericytes and stromal cells, capillary hemangioblastomas harbor cells containing and perhaps producing renin substrate and/or erythropoietin or a substance with similar antigenic determinants.

Capillary hemangioblastoma: histogenesis of stromal cells

The histogenesis of stromal cells in capillary hemangioblastoma has been the subject of debate. The light and electron microscopic studies of hemangioblastomas presented here showed pericytic and leiomyoblastic features in stromal cells. Cells cultured by the monolayer method showed similar features to those of the original tumors. Immunohistochemical studies for glial fibrillary acidic protein and factor VIII/von Willebrand factor indicated that stromal cells were antigenically distinct from astrocytes and endothelial cells. These findings suggest that stromal cells are closely related to pericytes and smooth muscle cells, and support Rhodin's speculation that pericytes serve as a precursor to smooth muscle cells.

Angiogenesis from mononuclear cells in thrombi

In organizing thrombi angiogenesis is not dependent on invasion of vasa vasora from the vascular wall. Mononuclear cells of the monohistiocytic system are always present within the clotted blood and are capable of differentiation into various types of mesenchymal cells, including endothelial cells. At first autolytic slits and clefts appear in the fibrinous superficial areas of the thrombus. They are gradually lined by spindle-shaped "pre-endothelial" cells that already possess immunohistological properties of endothelial cells but still resemble primitive mesenchymal cells ultrastructurally. Later these cells gain connection with each other by pseudopodia, overlapping and interdigitation until the channels in the fibrinous matrix are covered by an uninterrupted layer of cells. These cells are now characterized ultrastructurally by the appearance of specific endothelial organelles (Weibel-Palade bodies). Circulation within these channels begins from the blood stream. In addition, angiogenesis by sprouting of vasa vasora from the vascular wall occurs in those areas of the thrombus in contact with the vessel wall. In blood vessels with on unimpaired intimal layer, angiogenesis by invasion of capillaries occurs at an earlier date than capillary formation by mononuclear cells.

Selective localization of gamma-enolase in stromal cells of cerebellar hemangioblastomas

Three cases of cerebellar hemangioblastoma were studied using the immunoperoxidase technique to localize gamma-enolase, also known as neuron-specific enolase. The stromal cells demonstrated positive staining for gamma-enolase, while endothelial cells and pericytes showed no reactivity. Two vascular lesions, an angiosarcoma and a cutaneous angioma, were studied and found to be nonreactive for gamma-enolase. All tumors were also tested for factor VIII/von Willebrand factor, glial fibrillary acidic protein, and the S-100 protein. The lack of expression of gamma-enolase in endothelial cells of hemangioblastomas demonstrates a clear antigenic distinction from neighboring gamma-enolase-positive stromal cells. The significance of this finding and its implications for stromal cell histogenesis are discussed.

Ultrastructure of cerebellar capillary hemangioblastoma. VI. Concentric lamellar bodies of endoplasmic reticulum in stromal cells

Concentric lamellar bodies of endoplasmic reticulum (CLB) were found in the stromal cells of all five cases of cerebellar capillary hemangioblastoma studied ultrastructurally. CLB were often present in the stromal cells with voluminous loose cytoplasm, particularly those close to the capillaries. They were rarely seen in small stromal cells with abundant organelles and stromal cells distended by large lipid droplets. Small lipid droplets were usually present in the center or in the vicinity of CLB. Vesiculation and vacuolization of the lamellar arrays of CLB were common. Some vacuolized CLB were transformed into large, varying-shaped, multilocular bodies. Some stromal cells were markedly distended by numerous large vacuoles derived from CLB. Granulo-fibrillary material was frequently present in the vacuolized lamellae. Discharge of vacuoles into the interstitial space was observed. It is suggested that CLB is one of the characteristic ultrastructural features of the stromal cells. They may represent a special type of hyperplasia of the endoplasmic reticulum, but their functional significance is not known.

Multifocal spinal angiosarcoma after chordotomy

A male aged 60 is reported who, 5 years after chordotomy at the Th 2/3 level, developed acute paraplegia of the legs and a sensory transverse lesion due to an extradural tumour of the Th 1-4 level. Neuropathology revealed transverse necrosis of the thoracic spinal cord (Th 1-4) due to an intradural tumour at the upper thoracic and lumbar spinal levels, the thoracic malignancy arising at the site of the previous chordotomy, with a suture being observed within the tumour mass. Histology, positive immunostaining of tumour cells with Factor VIII antigen, a specific marker of endothelial cells and the ultrastructural demonstration of Weibel-Palade bodies in endothelial cells of the tumour vessels suggested a malignant mesenchymal tumour of angiosarcoma type presumably arising from the spinal meninges, and broadly invading the spinal cord. The usual relation of this extremely rare intraspinal vasoformative malignancy to previous chordotomy is discussed.

Ultrastructure of cerebellar capillary hemangioblastoma. V. Large pinocytic vacuolar bodies (megalopinocytic vesicles) in endothelial cells

Large pinocytic vacuolar bodies (megalopinocytic vesicles) containing electron-dense granulo-fibrillary material, not previously described in micro-vascular endothelium of brain tumors, were observed in endothelial cells of all five cases of cerebellar hemangioblastoma studied ultrastructurally. They were present in 23% of a total of 132 capillary profiles studied. Some were prominent and aggregated to occupy a large portion of the endothelial cytoplasm. Unlike the ordinary pinocytic vesicles in endothelial cells, they were distributed predominantly in the vicinity of the nucleus and surrounded by abundant organelles. They were irregular and usually several times larger than macropinocytic vesicles. The larger vacuolar bodies were often surrounded by bundles of microfilaments which often anchored on their limiting membrane. They coexisted frequently with Weibel-Palade bodies and occasionally fused with them. Convergence of coated vesicles and micropinocytic vesicles with the vacuolar bodies was present. However, there was no direct contact between the vacuolar bodies and Golgi apparatus, rough and smooth endoplasmic reticulum and mitochondria. The vacuolar bodies were closely associated with pericytic foot processes. It was suggested that they were formed by invagination of the abluminal cytoplasmic membrane with engulfed extracellular material and migrated internally. Discharge of their contents into the vascular lumen and interendothelial space was observed. Some had a disrupted membrane with a suggestion of release of contents into the cytoplasmic matrix. Their function is unknown, but they may serve as a specific vehicle of transport or digestive mechanism in microvascular endothelium under certain pathophysiological conditions, such as neoplasm, to meet the increasing metabolic demands.

Ultrastructure of cerebellar capillary hemangioblastoma. IV. Pericytes and their relationship to endothelial cells

Electron microscopy and computerized morphometric techniques were employed to examine pericyte ultrastructure and to assess quantitatively their relationship to endothelial cells in five cases of cerebellar capillary hemangioblastoma. A total of 97 cross-sectioned capillary profiles were studied. Pericyte coverage of capillary ranged from 30.2% to 97.3% with a mean value of 68.7%, which is higher as compared with the available data from the cerebral cortex, skeletal and cardiac muscle, and pulmonary capillaries. The higher pericyte coverage of capillary suggests that pericyte is an active component of cerebellar capillary hemangioblastoma and may have a close functional relationship to endothelial cells. Pericytes contained bundles of parallel microfilaments along the adluminal side and in the terminal processes, and exhibited an intimate "peg-and-socket" relationship with endothelial cells, suggesting a contractile function of pericytes and their possible role in regulating capillary lumina and focal blood flow. The finding of abundant micropinocytic vesicles along the abluminal side of the cytoplasmic membrane indicates an active metabolic exchange between pericytes and the interstitium. It is possible that in cerebellar hemangioblastoma pericytes may act as a mechanical and metabolic monitor barrier for endothelial cells.

The distribution of laminin in human brain tumors: an immunohistochemical study

The immunohistochemical distribution of laminin in 70 cases of primary and secondary brain tumors has been studied. The sections were fixed in Carnoy, embedded in paraffin, and treated with collagenase before applying the specific immune serum. In normal neural tissue and in gliomas, the distribution of laminin overlaps with that of basement membrane, as is known from observations on ultrastructure in the literature. The overlapping was observed also in neurinomas, papillomas of the choroid plexus, ependymomas, and meningiomas. Problems arise in the interpretation of the results in the other oncotypes. In hemangiopericytomas and hemangioblastomas, laminin demonstrates a basement membrane around the vessels only; it is absent around stromal cells. In desmoplastic medulloblastomas, laminin forms a network among the tumor cells. In primary lymphomas, concentric rings of laminin are evidenced around some vessels. In discussing the results, the ultrastructural distribution of basement membranes is taken into account.

Ultrastructure of cerebellar hemangioblastoma. Some new observations on the stromal cells

Five cases of hemangioblastoma were studied by electron microscopy with particular attention to the stromal cells and their surrounding structures. Most of the stromal cells of the tumor had abundant clear cytoplasm containing rough endoplasmic reticulum, mitochondria, scattered fibrils, and large lipid inclusions. They were usually aggregated without intervening cells. In the perivascular areas, their surfaces facing the perivascular collagen were surrounded by basal lamina. Their apposed cell membranes had occasional adhesive devices. Occasional, long, apparently cylindrical processes of the stromal cell cytoplasm were observed in some cases. These processes contained intermediate filaments of undetermined nature and microtubules. In the border zone between the tumor and the surrounding brain, the stromal cells were occasionally surrounded by narrow sheets of dark cell processes containing fibrils and glycogen granules, consistent with astrocytic processes. Altered neuronal elements were also observed in this area.

Suprasellar hemangioblastoma

A case of suprasellar hemangioblastoma attached to the pituitary stalk is reviewed. The patient presented with amenorrhea-galactorrhea and a highly vascularized suprasellar lesion. Though the exact diagnosis was not made before the operation, the authors emphasize the importance of angiography, which had significant features regarding the diagnosis.

Hemangioblastoma of the central nervous system: nature of the stromal cells as studied by the immunoperoxidase technique

Ten hemangioblastomas of the central nervous system were examined by an immunoperoxidase technique for glial fibrillary acidic protein (GFAP), S-100 protein, and Factor VIII-related antigen to determine the origin of the stromal cells. In seven cases scattered stromal cells were positive for GFAP, and eight cases showed variable numbers of S-100 protein-positive cells. These positive cells were present throughout the tumors. S-100 protein-positive stromal cells corresponded to GFAP-positive cells, but the former were more numerous than the latter. Staining for Factor VIII-related antigen was negative in stromal cells, except in endothelial cells lining capillaries. It was suggested that stromal cells of capillary hemangioblastomas are composed by heterogeneous cell populations.

Immunohistochemical study of fibronectin in hemangioblastomas and hemangiopericytomas

Eight hemangioblastomas and two hemangiopericytomas were studied using indirect immunoperoxidase stains for fibronectin (FN) and glial fibrillary acidic protein (GFAP) in formalin-fixed, paraffin-embedded surgical specimens. Stromal cells in hemangioblastomas were GFAP-negative and showed variable FN expression, while GFAP-positive cells were FN-negative, thus suggesting that the stromal cells are not derived from astrocytes. Hemangiopericytoma cells were poorly to intermediately FN-positive. The origin of stromal cells is discussed in the light of their fine structure and the immunohistochemical stains with other cell markers.

Ultrastructure of cerebellar capillary hemangioblastoma. II. Mast cells and angiogenesis

The topographic distribution, population density, and ultrastructural features of mast cells were studied in six cases of cerebellar capillary hemangioblastoma. The vascular area of tumor tissue contained large numbers of mast cells (6.3 cells/high power field, X 400) in comparison with hyalinized area (0.3 cell) and adjacent cerebellar tissue (less than 0.1 cell). Close association of mast cells with endothelial cells and stromal cells was found. The morphology of mast cell granules and their degranulation through dissolution of granule contents and exocytosis were illustrated. The findings suggest that an increased number of mast cells may represent one of the characteristic histological features of capillary hemangioblastoma, and continuous degranulation of mast cell granules with release of heparin may play an important pathophysiologic role in the vascular proliferation and expansion of the tumor.

von Hippel angiomatosis. A light, electron microscopic, and immunoperoxidase characterization

A 25-year-old Iranian man had undergone eye wall resection of a large von Hippel angioma to alleviate an exaggerated macular response, affording study by light and electron microscopy and immunohistochemistry before the obfuscatory effects of long-standing exudative retinal detachment, gliosis, or iatrogenic ablation supervened. We used this vantage point to assess the interrelation between the component endothelial cells, pericytes, and stromal foam cells. On the basis of staining with glial fibrillary acidic protein, factor VIII, the C3 fraction of complement, fibrinogen, and lysozyme, it is unlikely that stromal foam cells derive from glial precursors, but may represent degenerating cells, perhaps arising from a common vasoformative stem cell under hypoxic stress.

Distribution of endothelial and basement membrane markers in angiogenic tumors of the nervous system

The distribution of two endothelial cell markers Factor-VIII-related antigen and Ulex europaeus agglutinin was examined by immunoperoxidase and immunofluorescence techniques in paraffin-embedded specimens representing the three main types of angiogenic neoplasms of the nervous system, hemangioblastoma, hemangioendothelioma and hemangiopericytoma. In addition, the distribution of the basement membrane (BM) marker, laminin, was studied in the same tumors. It was found that Ulex europaeus agglutinin was a more sensitive marker of neoplastic endothelial cells than Factor-VIII-related antigen. Both markers only stained endothelial cells, while the tumor cells of hemangiopericytomas and the stromal cells of hemangioblastomas remained unstained. These findings do not support the view that the stromal cells of hemangioblastomas are derived from endothelial cells. With antiserum to laminin a typical staining pattern could be noticed in each tumor, showing the architectural relationships of the cells very clearly. In all three tumor types laminin was only found in the BM of the vessels, not in the interstices of the neoplastic cells outside vessel lumina. Therefore, the reticulin network previously found between the individual cells of hemangiopericytomas does not correspond to BM. It is concluded that both Ulex europaeus agglutinin and laminin antisera could be valuable new aids for the diagnosis of the three tumor types.

Invited review. Nervous system antigens

Some of the better characterized proteins (markers) of the nervous system are described. The availability of specific antibodies to these markers has allowed the localization and assay of the proteins in tissue and biological fluids. There is some evidence that autosensitization may occur. Clinical application of these markers includes the evaluation and prognostic significance after stroke and head injury. The diagnostic histopathological use of the markers in the investigation of various tumours is summarized.

Cells constituting cerebellar hemangioblastomas. Ultrastructural study

Five capillary hemangioblastomas exhibiting a range of histologic variations common to this tumor were studied using electron microscopy. The capillary hemangioblastoma were composed commonly of three cell lines -- stromal cells, endothelial cells and pericytes. In addition, extramedullary hematopoietic foci were seen in the tissue of one case. We regarded all these cellular elements as neoplastic components. The interconvertibility among them was not confirmed. The capillary hemangioblastomas were highly organized by those multiple cell lines. The histologic pattern of growth was arbitrarily subgrouped into stromal cell prominent type and capillary prominent type. Intermediate features between the two types were observed. These different types would depend on relative proportions and the degree of maturity of the constituting cell elements. From the histogenetic point of view, we considered capillary hemangioblastomas as being a hamartomatous tumor.

Localization of factor VIII/von Willebrand factor and glial fibrillary acidic protein in the hemangioblastoma: implications for stromal cell histogenesis

The histogenesis of hemangioblastoma stromal cells is unresolved. Ultrastructural observations suggest that the stromal cells, endothelial cells, and pericytes that compose this neoplasm are all derived from angiogenic mesenchyme. The expression of factor VIII/von Willebrand factor (FVIII/vWF), a specific marker for endothelial cells, and of glial fibrillary acidic protein (GFAP), a specific marker for glial cells, was examined in 16 hemangioblastomas using the peroxidase-antiperoxidase immunohistochemical method. Endothelial cell staining for FVIII/vWF was intense in 14 tumors, weak in one, and absent in another. There was no stromal cell staining in any of the neoplasms. Process-bearing, GFAP-positive cells were observed near the tumor margin in 13 cases, and deeper in the neoplasm in 8. In two of these tumors there were also occasional GFAP-positive cells that lacked processes and had a vacuolated cytoplasm. Virtually all of the GFAP-positive cells were interpreted as trapped astrocytes rather than stromal cells. The lack of expression of FVIII/vWF by the stromal cells indicates that they are antigenically distinct from endothelial cells. Several alternatives for stromal cell histogenesis remain open. The stromal undergone antigenic loss, or from angiogenic mesenchymal cells that do not express FVIII/vWF. Alternatively, the stromal cells may originate from non-angiogenic mesenchymal cells derived from the mesoderm or neuroectoderm.

Hemangioblastomas: histogenesis of the stromal cell studied by immunocytochemistry

Twenty-one cases of hemangioblastoma from the cerebellum, spinal cord and retina were studied using the unlabeled antibody peroxidase-antiperoxidase technique with antibodies directed against glial fibrillary acidic protein (GFAP) and factor VIII related antigen (VIIIR:Ag). In 19 of 21 cases studied with anti-GFAP, astrocytes were identified peripherally, and in 13 cases they were found centrally within the tumor. In no instance did stromal cells react positively for GFAP. Sixteen cases with anti-VIIIR:Ag antibody were examined, and in all cases many stromal cells showed positive staining. It is concluded that the stromal cells were of endothelial origin. The occasional stromal cells that other investigators have identified as reacting positively for GFAP may represent stromal cells capable of ingesting extracellular GFAP derived from reactive astrocytes within the tumor, or they may be lipidized astrocytes.

The Weibel-Palade Body in the diagnosis of endothelial tumors

The Weibel-Palade body (WPB), a cytoplasmic marker for endothelial cells, was utilized in this ultrastructural study to confirm the light microscopic diagnosis in four different neoplasms of suspected endothelial origin. The WPB was prominent in benign endothelial neoplasms but was less so or absent in the malignant counterpart.