Kenneth M. Earle

Primary malignant lymphomas of the central nervous system

Eighty‐three cases of primary malignant lymphomas of the central nervous system (CNS) from the files of the AFIP were studied according to various clinical and pathologic parameters. The histologic patterns observed are analogous to those seen in the spectrum of malignant lymphomas arising in the reticuloendothelial system of other organs. The authors favor the diagnosis of primary malignant lymphoma of the CNS rather than that of “reticulum cell sarcoma” or “microgliomatosis” used in the past. Lesions are frequently multifocal, and surgery, other than for diagnostic biopsy, is not usually beneficial. The clinical course can be significantly prolonged by radiation therapy.

Primitive neuroectodermal tumors of the brain in children.

Predominantly undifferentiated tumors occurring in the cerebrum of young individuals are referred to as “primitive neuroectodermal tumors.” Twenty‐three of these cases were collected which had certain common features. Grossly they tended to be cystic and compressed adjacent brain. Microscopically they were malignant‐appearing and demonstrated a prominent mesenchymal component. Sixteen cases showed focal evidence of glial and/or neuronal‐appearing differentiation. It is suggested that the mesenchyme is also an aspect of tumor differentiation. The biologic behavior of these tumors was malignant, with an average duration of 18 months from onset of symptoms to death.

Medulloblastoma. A report of 201 cases with emphasis on the relationship of histologic variants to survival

Medulloblastoma has invariably been associated with a poor prognosis. However, it has been shown that such tumors in adults have a slightly better prognosis than in children. We have studied 201 such neoplasms and attempted to correlate survival with several factors. In our series, adults survived longer (average 50 months) than children (average 11 months), and females (average 31 months) slightly longer than males (21 months). Location of the primary tumor was also of significance since patients with neoplasms primarily located in a cerebellar hemisphere showed a better survival (47 months) than those located in the cerebellar midline (17 months). The histologic typing of the tumor was also important. Patients with “desmoplastic” medulloblastomas had an average survival of 51 months, while those with the “classical” medulloblastomas had an average of 18 months only. The majority of the desmoplastic neoplasms occurred in adults and in cerebellar hemispheres rather than the midline. Further differentiation within the tumor toward the neuroblastic or the glial lines was evident in 51 neoplasms, and no significant differences in survival were noted among them. Four patients eventually developed extracranial metastases, and two were associated with meningiomas.

Contiguous glioblastoma multiforme and fibrosarcoma with extracranial metastasis.

In our review of 23 patients with metastasizing glioblastoma multiforme, 7 cases were found to have a combination of both glioblastoma multiforme and fibrosarcoma at the primary site. The metastatic foci, however, had a comparable admixture of neoplastic elements in only 5 patients and were composed solely of the sarcomatous component in the other 2. Such neoplastic combinations were not found among the other metastasizing neuroectodermal tumors in our files. Only 2 other well‐documented case reports have been located that show similar tumors with extracranial metastasis. The pathogenesis of the sarcomatous changes is discussed briefly. Whether the gliomatous or sarcomatous components of these unique neoplasms are induced by one or die other remains conjectural. This study reaffirms that glioblastoma multiforme is the most common neuroectodermal tumor to occur in combination with a sarcoma. The greater incidence of extracranial metastasis among these combination neoplasms underscores their significance and demonstrates not only a difference in their biologic behavior but possibly their pathogenesis.

Ultrastructural Studies of Olivopontocerebellar Atrophy

Three cases of olivopontocerebellar atrophy, one of which included a cerebellar biopsy, have been examined for ultrastructural changes. Degenerative changes were identified within the afferent cerebellar fibers and within the cerebellar neurons, especially the Purkinje cells. Although the majority of the degenerative alterations have been previously described in a variety of disease states, there were some findings seen in our material that have not been previously reported, including unusual striped bodies and Lafora body inclusions within Purkinje dendrites. The relationship between OPCA and other diseases is discussed and a possible slow-viral etiology is considered.

Traumatic distortions of the primate head and chest: correlation of biomechanical, radiological and pathological data

High speed cinefluorographic studies were performed on anesthetized primates during graded, experimental blunt impacts of the head or chest. Cineframe data were analyzed frame by frame to identify dynamic anatomic movement patterns during each injury. The results indicate that the brain and heart undergo significant displacements within the first few milliseconds (ms) post-impact and these transient interior motions were correlated with physiologic and pathologic changes as well as impact force and deceleration.

The ethnic distribution of primary central nervous system tumors: AFIP, 1958 to 1970.

A retrospective ethnic study was made of 16,311 cases of primary central nervous system (CNS) tumors seen at the Armed Forces Institute of Pathology (AFIP), Washington, D.C, from 1958 to 1970. Results showed a considerably higher Caucasian:Negro (C:N) case ratio (13.7:1) than the C:N population ratio (8.4:1), indicating a higher relative frequency of primary CNS tumors in American Caucasians as compared to American Negroes. The glioma was significantly more frequent in Caucasians than in Negroes (p < 0.005). In contrast, Negroes had an excess of the pituitary adenoma as compared to Caucasians (p < 0.01). The proportional frequencies of the meningioma and the nerve sheath tumor were also higher in Negroes than in Caucasians. When this pattern of the tumor distribution of American Negroes was compared to that of African Negroes (a composite African series), the preponderance of the pituitary adenoma and the meningioma and the relative paucity of the glioma in the Negro race as compared to Caucasians were again confirmed. The differences in the relative frequency and the tumor distribution between American Negroes and Caucasians and the considerable similarity of the tumor distribution between American and African Negroes emphasize the importance of genetic factors in the development of at least some primary CNS tumors.

X-Ray Fluorescent Spectroscopy of Brain Tissue in Cases of Parkinson’s Disease

Histological studies were performed on 105 cases of Parkinson’s disease in the files of the Armed Forces Institute of Pathology. The principal pathological changes will be reviewed.