3H-thymidine autoradiography of CSF cells in primary reticulum cell sarcoma of the brain

MIB1 staining index and scoring of histologic features in meningioma. Indicators for the prediction of biologic potential and postoperative management

BACKGROUND

The biology of brain tumors, including cell kinetics, has been studied. Recently, monoclonal antibody to Ki67 (MIB1), a nuclear protein related to cell proliferation, has been analyzed immunohistochemically using tissue prepared from paraffin embedded sections.

METHODS

The authors assessed the prognostic usefulness of various histologic indicators of the biologic potential of meningiomas in patients who underwent total resection (Simpson's Grade I and II) by evaluating the time to recurrence as an end point. Forty-three patients with a total of 36 meningiomas and 7 hemangiopericytomas were investigated by immunohistochemical analysis using MIB1.

RESULTS

MIB1 staining index (SI) and histologic score were well correlated with the recurrence-free interval (r = -0.6749, P = 0.002 and r = -0.4939, P = 0.027, respectively) and with each other (r = 0.7909, P < 0.001). The MIB1 SI and histologic score in the nonrecurrence group were significantly lower than those in the recurrence/metastasis group (P < 0.001 and P = 0.001, respectively). The values of these indicators showed that as the value increased, so did the recurrence rate.

CONCLUSIONS

Evaluation using the MIB1 SI and total histologic score of meningioma is useful in assessing the prognosis as well as postoperative management of these patients.

Proliferative activity of meningiomas as evaluated by bromodeoxyuridine uptake examination

Proliferative activity of meningiomas was examined in 12 consecutive cases by administering bromodeoxyuridine (BrdU) before surgical removal and by immunohistochemical staining of the removed tumours using anti-BrdU monoclonal antibody (anti-BrdU MAb) to detect BrdU-labelled tumour cells. The 12 cases consisted of 6 with a primary tumour and 6 with a recurrent tumour. All of the tumours contained labelled cells and the labelling index (LI) was obtained in each tumour. The highest average LI was 13.6% and the second highest was 9.0% both in recurrent cases of histologically malignant meningothelial meningioma. The high LIs of both cases were thought to correspond well with the rapid recurrence of the tumour. The average LI of a case of recurrent haemangiopericytic tumour was 2.0%, and that of a case of meningioma associated with von Recklinghausen disease was 1.5%. The other 8 meningiomas showed the average LIs ranging from 0.1 to 0.9%, which were considered to be the LIs of usual benign meningiomas. The results of the BrdU uptake examination was considered to reflect well the clinical behaviour of meningiomas. The usefulness of the BrdU uptake examination in brain tumours, which can be employed in the clinical practice without any serious side-effects, is stressed.

Origin, proliferation, and fate of cerebrospinal fluid cells. A review on cerebrospinal fluid cell kinetics

Four aspects of cytokinetic investigations of cerebrospinal fluid cells were reviewed: the origin of these cells, their ability to divide, their fate, and the alterations occurring under pathologic conditions. Animal experiments and in vitro reactions of human cerebrospinal fluid cells indicated that, under normal and pathologic conditions, blood lymphocytes and blood monocytes are capable of leaving the vascular system inside the subarachnoid space. When these cells are located extravascularily, they seldom divide in the subarachnoid space under normal conditions. Migration via lymphatic pathways is possible, at lest under pathologic conditions. Cell turnover, as a whole, is extremely low under normal conditions. It is markedly altered by meningeal inflammation and meningeal tumor cell dissemination. Diagnostic significance other than morphology cannot yet result from cytokinetic investigations of cerebrospinal fluid cytology; prognostic significance may be possible.

Cytostatic treatment of meningeal blastoses

Intrathecal treatment with MTX was attempted in patients with diffuse meningeal blastoses. As a rule, symptoms and clinical findings improved rapidly. As objective parameters, the differential cell pictures of the CSF showed dissimilar results during therapy (25 mg MTX weekly i.t.). In leukoses (n = 10) and malignant lymphomas (n = 12), the CSF could be cleared with three exceptions which concerned differentiated tumors. The success was similarly good with meningeal dissemination of a seminoma. Meningeal carcinoses with mammary carcinoma (n = 7) and melanoma (n = 2) showed dissimilar results. No alteration of the cytograms of four bronchial carcinomas and one colon carcinoma was demonstrable. Besides the growth form, the degree of differentiation appears to be decisive for the success of therapy. The labeling index appears to be a useful indicator. Since symptoms and clinical findings often markedly improve even when a success cannot be objectively detected cytologically, an attempt at therapy is always to be recommended.

[Autoradiographic findings in cerebrospinal fluid cells (author's transl)]

The report concerns the results of autoradiographic studies of cerebrospinal fluid cells. We investigated pleocytosis in cases of inflammatory diseases of the central nervous system, hemorrhage in the cerebrospinal fluid space, brain tumor and hemoblastosis, as well as in cases of undefined neurologic disease. Cerebrospinal fluid was incubated with tritiated thymidine. The results show that tumor cells have the highest labeling index and monocytes the lowest. Cells from primary brain tumors incorporate tritiated thymidine more rarely and less intensely than cells from cerebral metastases. Lymphocytes from inflammatory disease in infants may demonstrate a high labeling index.

Proliferating cells in demyelinating states

Proliferation of mononuclear cells was examined with an autoradiography method in the CSF and peripheral blood of 13 patients with multiple sclerosis (MS), serially during activation of disease in one patient with subacute sclerosis panencephalitis (SSPE), and in some control patients with various neurological conditions. High cerebrospinal fluid (CSF) cell labelling indices, up to 1.7%, which could not be directly related to the clinical activity of the disease, were found in some MS patients. During activation of SSPE there was marked increase in labelled cells of CSF, up to 4.3%. In controls, corresponding CSF indices ranged from less than 0.1% to 0.4%. Mononuclear cells in CSF and peripheral blood behaved as clearly different cell populations.

Combined application of cytodiagnostic technics to the cerebrospinal fluid

The major purpose of the examination of the cells in the cerebrospinal fluid (CSF) is the diagnosis of malignant growths. However, unequivocal tumor cell diagnosis is often problematical, since cells of local origin can also demonstrate considerable proliferative activity and great morphological variety. In these circumstances, it is advisable to evaluate cells from several points of view. One can demonstrate morphological characteristics with panoptic staining and can gain an impression of the RNA content of a cell with acridine orange (AO) fluorescent stain. Quantitative measurements of DNA synthesis in vitro can be made by labelling with tritiated thymidine. Multidimensional cytodiagnosis gives a comprehensive impression of the quality of the cells in question and provides the clinician with information which can be valuable for subsequent diagnostic and therapeutic efforts.

Autoradiographic demonstration of proliferating cells in cerebrospinal fluid

The proliferative activity of cells, isolated from 82 human CSF specimens, was examined by 3H-thymidine autoradiography. High labelling indices (LI) were found in acute viral meningitis (up to 8 per cent) and radiculitis (up to 6 per cent). CSF cell proliferation was also shown in the subacute stages of viral diseases and in other inflammatory processes (LI ranging from 0.5 per cent to 3 per cent). Most of the cells labelled from these CSF specimens were large lymphocytes, "lymphoid cells" and plasmacytes. Their presence in CSF is presumed to indicate an immune reaction. By the demonstration of a proliferative activity of these cells, aseptic inflammatory processes can be differentiated from "unspecific" pleocytosis. Because of a correlation between the LI of CSF cells and the stages of some inflammations, this method is suggested for an assessment of pregression or remission of chronic processes, e.g. "chronic meningitis" and multiple sclerosis. It can also be used in experimental research: the same type of mononuclear cells was labelled after having been cultured for 23 hours prior to the incubation with 3H-thymidine. Proliferating tumor cells as well as proliferating non-neoplastic mononuclear cells were demonstrated in CSF from various neoplastic diseases. In the clinical diagnosis of these processes, the method is of limited value. It proved very useful, however, for an assessment of the therapeutic effects of intrathecal cytostatic therapy. CSF specimens from non-inflammatory and non-neoplastic diseases regularly contained very few proliferating cells (LI: less than 0.1).

Intrathecal cytostatic therapy of meningeal carcinomatosis. Autoradiographic investigations of the CSF cells

Autoradiographic investigations with 3H-thymidine were performed on cerebrospinal fluid (CSF) cells from a case of meningeal carcinomatosis following carcinoma of the breast. The cells were found to be anaplastic histologically. Within a period of 12 days 3 X 25 mg methotrexate were injected into the subarachnoid space by lumbar (2 X) or cisternal (1 X) puncture. The CSF cells were reduced from 283/3 to 19/3, while the proportion of tumour cells fell from 90 to 2%. The labelling index before onset of therapy was 33%; it increased to 70% after the first intrathecal administration of cytostatic and finally fell to 23%. The mitotic index, which was generally less reliable, behaved in a parallel way; the initial value of 1.5% increased to 3% and then declined to values less than 0.5%. Despite detailed histological investigation, carcinomatous cells could not be found anywhere on the surfaces of the central nervous system or meninges. Clinically, the patient had never shown significant neuropathological or psychopathological findings. However, the headache which had been very severe during the meningeal carcinomatosis vanished completely after the second application of methotrexate.

3H-thymidine autoradiography of the CSF cells in cases of non-neoplastic disease

Human CSF cells in cases of non-neoplastic disease of the central nervous system (CNS) were examined in vitro by 3H-thymidine autoradiography. Immediately after withdrawl by lumbar or ventricular puncture, the CSF was incubated in a sedimentation chamber at 37 degrees C for 1 hr with an admixture of 3H-thymidine at a concentration of 1-2 muCi/ml CSF. In a few cases the CSF withdrawn was incubated in a glass tube in the same condition as in a sedimentation chamber, and the CSF cells were collected by centrifugation. The CSF cells collected were fixed in methanol and the microautoradiographic procedure was performed. Labeled CSF cells were found in 21 cases out of 22. The average labeling index of the total nucleated cells was 0.22% with the highest labeling of 0.74%. Almost all the labeled cells were thought to be medium to large sized lymphocytes and monocytoids. Peripheral blood was examined by a similar method and the results were compared with those of the CSF. It may be noteworthy that thre exist DNA synthesizing cells in the CSF even in a non-neoplastic state of the CNS, although the number is not large.