Clinical, histopathological and immunohistochemical profile of central neurocytomas: An institutional series and literature review

Abstract

Aim: Central neurocytomas are rare intra ventricular tumors, which are largely benign in both histology and clinical picture, though a subset of patients with tumor demonstrating clinically aggressive nature exists. This study analyzes the clinicopathological profile of neurocytoma, and aims to identify potential histopathological, and immunohistochemical factors that may govern the behavior and recurrence of these tumors. Materials and Methods: A retrospective analysis of 22 patients of central neurocytoma managed surgically at our institution from 1997 to 2006 was performed. Histopathology was reviewed; Immunohistochemistry to assess synaptophysin, glial fibrillary acidic protein (GFAP) expression and Ki-67 labeling (LI) index was performed. Results: The mean age at presentation was 27.9 years with an equal number of male and female patients. Fourteen patients underwent surgery by transcallosal approach and eight by transcortical approach. Gross total or near total tumor decompression was performed in 13 out of 22 patients (59%). Adjuvant therapy was not advised following primary surgery. Tumor recurrence was documented in three patients. The time to recurrence ranged from 21 to 61 months. Histopathological variations such as intra-tumoral hypercellularity, necrosis, ganglionic cell differentiation, and tumor cell GFAP expression were noted; which however, did not show any significance with respect to predicting recurrence. The initial mean Ki-67 LI index of recurrent tumors was 4±3.5 versus 2.3±2.1 in the ones that did not recur, but this difference was not statistically significant. Conclusions: Central neurocytomas are rare tumors, which are largely benign, with a good prognosis. Management needs to be individualized and recurrences can occur even after total resection. Immunohistochemical findings assist in establishing the diagnosis. The behavior of the tumor is not always predictable and recurrent tumors are often more aggressive than the primary.

Keywords

• Central neurocytoma
• histopathology
• immunohistochemistry
• management
• recurrence
• surgery