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Histochemical staining using lectins from Ricinus communis (RCA-1), Arachis hypogaea, and Canavalia ensiformis was investigated in 40 human gliomas, three central neurocytomas, one human neuroblastoma cell line (IMR-32), and two normal brain tissues. Staining was uniform in low-grade gliomas, but heterogeneous in high-grade gliomas, particularly with RCA-1. The correlation between RCA-1 reactivity and cellular proliferative potential was investigated in 10 high-grade gliomas using a combined staining technique: the silver colloid method for nucleolar organizer regions (Ag-NORs) and histochemistry with RCA-l. The mean number of Ag-NORs counted on a simple preparation was significantly greater in the nuclei of RCA-1-negative cells than in those of RCA-1-positive cells (p < 0.001). The staining intensity of inflammatory cells was obviously higher than that of neoplastic cells, and therefore inflammatory cells were easily discriminated from neoplastic cells. Combined RCA-1 histochemical and Ag-NOR silver colloid staining revealed heterogeneous expression of RCA-1 receptor in high-grade gliomas with changes in Ag-NOR number. This result seems to show that high-grade gliomas express heterogeneous cellular carbohydrate structure and proliferative potential even within the same tumor.

A rare case of intracranial primary chondroid chordoma is reported with special reference to neuroradiological findings. A precontrast computed tomographic (CT) scan revealed an isodense mass with multiple flecks in the right cerebellopontine region. A postcontrast CT scan showed slight ring enhancement. A delayed postcontrast CT scan demonstrated marked homogeneous enhancement extending from the middle cranial fossa to the cerebellopontine region on the right. Magnetic resonance (MR) imaging demonstrated a well-defined lesion as a high-intensity mass on T2-weighted image and a low-intensity mass on T1-weighted image. A MR image 5 minutes after gadolinium-diethylenetriaminepenta-acetic acid administration showed heterogeneous enhancement. A MR image 30 minutes after the contrast administration showed more marked, homogeneous enhancement. Such delayed postcontrast CT and MR imaging are useful in the differentiation of chondroid chordoma from classical chordoma.

Investigation of lectin cytochemical staining of inflammatory cells in human gliomas showed that Allomyrina dichotoma (Allo-A) cytochemistry can reliably distinguish inflammatory from neoplastic cells. Allo-A cytochemistry combined with silver colloid staining of argyrophilic nucleolar organizer regions (Ag-NORs) was performed in human gliomas. Inflammatory cells possessed usually one but sometimes two Ag-NORs and macrophages often possessed several Ag-NORs. The mean Ag-NOR number per nucleus of inflammatory cells ranged from 1.81 to 2.34, and that of neoplastic cells ranged from 2.57 to 3.53 and from 2.84 to 4.46 in low- and high-grade gliomas, respectively. The mean Ag-NOR number per nucleus of inflammatory cells was significantly smaller than that of neoplastic cells (p less than 0.001). Combined Allo-A cytochemical and silver colloid Ag-NOR staining can provide a reliable Ag-NOR number in human gliomas by distinguishing inflammatory cells.

Tumors at the trigone of the lateral ventricles are relatively rare. The authors have operated on eight cases with trigonal tumors during a 10-year period. Four cases were true intraventricular tumors arising from the ventricular walls, consisting of two meningiomas, one cavernous angioma, and one choroid plexus papilloma. On the other hand, the remaining four cases were paraventricular tumors originating in the adjacent brain and consisted of three astrocytomas and one glioblastoma multiforme. Although these trigonal tumors were readily detected with computed tomographic (CT) scanning, differential diagnosis was difficult because of their similar appearances on CT scans. The initial symptoms were headache in seven, and the neurological examination revealed personality changes, choked disc, visual field defects, hemiparesis, etc., in four, and no deficits in the remaining four cases. All cases were operated on via superior or middle temporal gyrus incision, and the surgical results were good except for one case who died of postoperative brain edema. In the four cases with tumors located in the dominant hemisphere, two were left with sensory aphasia, dyslexia, dyscalculia, and hemianopsia which improved within 6 months. In these two cases, postoperative CT scans revealed cerebrospinal fluid retention with severe edema along the surgical route which disappeared spontaneously within 3 months. We consider that the temporal gyrus incision was the safest approach, even though the tumor was located in the dominant side.

Subependymal giant-cell astrocytoma (SGCA), a rare intraventricular tumor, occurs mainly in young patients in conjunction with tuberous sclerosis (TS). This tumor arises characteristically from the medial part of the floor of the lateral ventricle, occluding the foramen of Monro. This report presents a rare adult case of SGCA, not associated with TS, which arose from the trigone of the lateral ventricle. The patient, a 42-year-old male, was admitted with episodes of psychomotor seizure for the past 2 years. The seizures consisted of hot sensations in his throat while breathing and of amnesic attacks. Electroencephalography showed occasional spike discharges localized in the right temporooccipital region. Computed tomography revealed the presence of an ovoid high density mass in the right trigone of the lateral ventricle with intense contrast enhancement. Surgery revealed a dark red, highly vascularized soft friable tumor. Light microscopic examination of the tumor characteristically showed cells of 3 morphological types, i.e. swollen gemistocytic cells, ganglion-like cells, and elongated and spindle-shaped cells. Mitoses and endothelial proliferations were extremely infrequent. Immunoreactive glial fibrillary acidic protein was present in the cytoplasm and processes of some smaller cells. Phosphotungstic-acid haematoxylin-positive fibrils were present in the perinuclear region of the spindle-shaped cells. Nissl's substances were seen at the margin of the cytoplasm of the ganglion-like giant cells.

Intracranial hemorrhages associated with meningiomas are extremely rare. A 36-year-old man was admitted with complaints of a dull headache, nausea, vomiting and a slight disorientation which persisted for a few weeks. CT showed a right subdural hematoma or effusion and high density areas in the right middle fossa and in the Sylvian fissure respectively. Right carotid angiography showed a very large avascular zone. On trepanation, a large subdural hematoma surrounded by typical outer and inner membranes was encountered and about 150 ml of dark brownish fluid was removed. A few days after the operation the same complaints as mentioned above reappeared and trepanation was repeated. Right fronto-temporal craniotomy was performed 8 days after the 2nd operation. During the operation a large subdural hematoma surrounded by firm capsules was found in the right fronto-parieto-temporal region. Part of a tumor originating from the right lateral third of the sphenoidal ridge protruded through the inner membrane into the hematoma cavity. A few small tumors were also found within the hematoma cavity. Most of the hematoma capsules and the tumor masses were removed and also another tumor mass growing in the Sylvian fissure was partially resected. Histological examinations showed the tumor to be a meningotheliomatous meningioma with sarcomatous changes. The patient died less than one month after the last operation. Postmortem examination disclosed numerous metastatic tumor masses throughout the central nervous system. Including the present case, a total of 15 reported cases of meningiomas associated with intracranial hematomas were reviewed and discussed.