About the Issue of Clinical and Morphologic Diagnosis of Intracranial Tumors

Abstract

Background: According to the literature data, there has been a significant increase in central nervous system tumors recently. The problem of neuro-oncology is to define the biological “behavior” of tumors, which carries the key importance for the respective effective treatment and prognostication. By informative value, radiologic studies take one of the leading place in the latest diagnostic methods established in the practical medicine; in addition, its known that regardless of informative value of any study method, the ultimate verification of the process is done based on morphologic study results. Thus, the knowledge of morphologic equivalents of the radiologic study data is of utmost significance, both for implementation of targeted treatment strategy as well as for defining the possible risk of relapse.   The aim of the study was to compare the clinical and postoperative morphological study results in presence of intracranial tumors.

Method: The postoperative material sampled during the 5 consecutive years was studied – 219 cases overall. Complete clinical-laboratory studies were performed in given cases, including MRI with T1flair,T2tse, T2flair, DWI, dADC-DWI, T1-FFE regimens, in axial, sagittal and coronal sections, with contrast enhancement (Magnevist, average 15 ml.).  In some cases per needed, MR angiography was performed (Ven-3D-PCA, 3DI-MC-HR). Postoperative material was fixed in neutral 10% formalin solution. Samples were paraffin-embedded. The sections with 5-6 µm thickness prepared by rotational microtome were stained by hematoxylin, eosin and picrofuxin (by Van Gieson). In some cases per needed, we were using the immunohistochemistry study method. Microscopic films were studied by light microscope “Balphan” (with halogen light) in different magnifications (200-400). The malignancy grade of tumors was defined by WHO classification 2007.

Results: Complete matching of the diagnoses was revealed in 131 cases (59.8%). In 26 cases of discrepant diagnosis, the clinical diagnosis indicated the histogenesis of intracranial tumor, which was not verified by morphology study. High indices of complete matching between clinical and postoperative morphology study data in intracranial tumors were observed for neurinoma (100.0%), pituitary adenoma (92.8%), meningioma (92.1%), and average indices of matching for glioblastoma (66.6%) and astrocytoma (62.5%) cases.

Discusion: Inclusion of stereotactic biopsy in the complex of preoperative assessment procedures for patients with intracranial tumors is strongly recommended, as the data of the above in most cases provides the verification of the process, which in future serves for the development of the optimal treatment strategy.