Patterns of differentiation in central neurocytoma

Summary

Central neurocytoma has been characterised by its intraventricular localisation, predominant occurrence in young adults, oligodendroglioma-like histology, benign course and ultrastructural evidence for neuronal differentiation. Eleven intraventricular central neurocytomas were studied histopathologically, employing cell type-specific immunocytochemical markers and electron microscopic analysis. In the past, these lesions have caused diagnostic problems since central neurocytomas share basic histopathological features with other periventricular neoplasms. Accordingly, several tumours of this series had previously been classified as ependymomas of the foramen of Monro or oligodendrogliomas. Although generally regarded as benign lesions, two central neurocytomas of this series showed histopathological evidence of anaplasia, with focal necrosis, mitotic activity and vascular proliferation. All central neurocytomas exhibited immunoreactivity for neuronspecific enolase and synaptophysin, indicating consistent neuronal differentiation. Three tumours were studied by electron microscopy and contained synaptic vesicles, neuritic processes and neurosecretory granules. In addition, one tumour contained ganglioid cells and this was associated with focal immunoreactivity for neurofilament protein, suggesting that some central neurocytomas may, at least focally, continue to differentiate towards the formation of mature neurons. Two of the tumours expressed glial fibrillary acidic protein in a considerable percentage of neoplastic cells which demonstrates a capacity for bipotential, i.e. glial and neuronal differentiation. We conclude that the central neurocytoma can be reliably diagnosed using antibodies to neuron-specific enolase and synaptophysin, and that histogenetically, this neoplasm is derived from a neuroectodermal precursor cell capable of both, neuronal and glial differentiation. The hypothesis is proposed that the central neurocytoma originates from the subependymal plate of the lateral ventricles, an embryonal matrix cell layer which postnatally maintains a limited proliferative potential.