Diagnostic decision-making in pathology
is a complex process. It involves gathering observational evidence and using this to
reason and decide which of a number of possible outcomes is most likely. The quality
of decision is influenced by many factors: previous experience, how one has been taught to
diagnose a specific group of diseases, the subjectivity or descriptive morphological
terminology, the individual's understanding of the underlying disease process, and how
fatigued the pathologist is when trying to make these judgments. These factors vary
considerably among pathologists and within the same individual at different times.
Tumoral grading and classification is a very important aspect of a diagnosis since the treatment and outcome of each case greatly depends on it. In order to judge about the tumoral grading and tumor diagnosis is necessary to know specifically the presence or absence of the histological features and their corresponding quantity (0 = absence; + = little, small quantity; ++ = intermediate, frequent; +++ = very frequent). The present collection of figures sample the fundamental histological categories to carry out the histological diagnosis and grading of the brain tumors.
1. Nodular Architecture: The tumor cells form separated big round or ovoid cellular formations.
Nod + Nod ++ Nod +++
2. Papillary Architecture: The tumor cells form papillary formations like
intestinal or plexus choroids formations with central vessels into the stromal axis.
Pap + Pap ++ Pap +++
3. Cystic Architecture: In the tumor tissue many cystic formations with or without epithelia are building.
Cys + Cys ++ Cys +++
4. Diffuse infiltration: the borders between the tumor proliferation and the normal tissue are more or less undefined.
Dif + Dif ++ Dif +++
5.
Nidus formation of nuclei: The nuclei
of the tumor cells build separated small groups.
Nid + Nid ++ Nid +++
6. Rows of nuclei: The nuclei of the tumor cells build rows or palisades with different length.
Row + Row ++ Row +++
7. Diffuse distribution of nuclei: The nuclei of the tumor cells build
homogeneous masses in all observed areas of the tumor tissue.
Did + Did ++ Did +++
8. Reticular arrangement of the tumor cells: the tumor
cells build meshes and intercellular spaces between their citoplasmatic prolongations.
Ret + Ret ++ Ret +++
9. Fascicular arrangement: the
tumor cells, most long cells, build bundles or fascicles oriented in different
directions.
Fas + Fas ++ Fas +++
10. Concentric arrangement: The tumor cells build
concentric formations with different diameters. Occasionally show central
calcifications.
Con + Con ++ Con +++
11. Perivascular arrangement: The tumor cells are ordered radial or in concentric formations around of the essel or build perivascular homogeneous masses.
Peri + Peri ++ Peri +++
12. Nuclear quantity: Different density of the cells in the tumors tissue.
Nuq + Nuq ++ Nuq +++
13. Necroses: Frequency
of circumscribed necroses into the tumor tissue.
Nec+ Nec ++ Nec +++
14. Hemorrhages: Quantity of blood masses into the tumor tissue.
Hem + Hem ++ Hem +++
15. Calcifications: Presence of calcified
masses into the tumor tissue.
Cal + Cal ++ Cal +++
16. Stroma: Quantity of collagen,
elastic or reticular fibers, with or without fibroblastic cells, but independent of
the vessels wall.
Stro + Strom ++ Strom +++
17. Vascularization: Quantity of vessel into
the tumor tissue.
Vas + Vas ++ Vas+++
18. Anomalous vessels: Presence of variations of
the vessel wall structure or
the circulatory vessel stretch.
AVa + AVa ++ AVa +++
19. Vascular occlusions: Presence of vascular thromben in the tumor tissue.
Thr + Thr ++ Thr +++
20. Tumorous invasion of vessels: Intravascular presence of tumor cells.
Tinv + Tinv ++ Tinv +++
21.
Cellular polymorphism: Variation of the forms
of the tumor cells.
Cpol + Cpol ++ Cpol +++
22. Average size of the Pericaryon: Average size of the separated tumor cells (In many brain tumors the limits of the cytoplasm cannot be seen)
Perz + Perz ++ Perz +++
Perz + ~ Lymphozyte; Perz ++ =1-3 Lymphozytes. Perz +++ ~ >4 Lymphozytes.
23. Nuclear polymorphism: Variations of the forms and size of the nuclei of the tumor cells.
Nupo + Nupo ++ Nupo +++
24. Size of the Nuclei: Average size of the nuclei of the tumor cells.
Nucs + Nucs ++ Nucs +++
25. Spherical nuclei: Quantity
of spherical nuclei into the tumor tissue.
Nues + Nues ++ Nues +++
26. Oval nuclei: Quantity
of oval nuclei into the tumor tissue.
Nuov + Nuov +++ Nuov +++
27.
Oblong nuclei: Quantity
of oblong and long nuclei into the tumor tissue.
Nuob + Nuob ++ Nuob +++
28. Annular arrangement of
the tumor cells with central lumen: Quantity of annular
formations of the cells into the tumor tissue with a central lumen like a gland or
ependymal formation.
Annuc + Annuc ++ Annuc +++
29. Annular arrangement of the tumor cells without central lumen: the annular cell formations into the tumor tissue show not central lumen, but fibrile formations of central cells.
Annun + Annun ++ Annun +++
30. Quantity of chromatin of the tumors cells: Average of
the chromatin density of the cells nuclei into the tumor tissue.
chrom + chrom ++ chrom +++
31. Typical mitoses: Quantity
of the normal figures of mitotic divisions of the tumor cells.
Tym + Tym ++ Tym +++
Mi-Ki-67 + Mi-Ki-67 ++ Mi-Ki67 +++
32. Atypical
mitoses: Quantity of the abnormal figures of mitotic
divisions of the tumor cells.
Atyp Atyp Atyp Atyp Atyp
Exemples of atypical mitoses
33. Glia fibers: Quantity
of glial fibers into the tumor tissue (gliomas) investigated with polarized light,
with special histologic methods or with immunohistological reactions (GFAP, Vimentin).
Glia + Glia ++ Glia +++
34. Degenerations except calcifications: Intracellular presence of foreign
substances, but not calcifications.
Dege + Dege ++ Dege +++
35. Lympho- granulo- plasma
cell infiltrations: Presence of
intratumoral cuff of inflammatory cells into the tumor tissue or immediately around of
the tumor tissue.
Lymp + Lymp ++ Lymp +++
36. Ependymal formations or ependymal tubes: Presence of clearly identified formations of ependymal celss into the tumor tissue.
Epen + Epen ++ Epen +++
37. Presence of nerve cells:
Intratumoral identified nerve cells (also with special histologic methods or with immunohistological reactions)
Nerv + Nerv ++ Nerv +++
38. Presence of astrocytes: Intratumoral clearly
identified astrocytes (with special histologic methods or with immunohistological
reactions like GFAP, Vimentin).
Astr + Astr ++ Astr +++
39. Presence of astroblasts:
Intratumoral clearly identified astroblasts (with special histologic methods or with
immunohistological reactions like GFAP, Vimentin).
Asbl + ++ +++
40. Presence of glioblasts:
Intratumoral clearly identified glioblasts (with special histologic methods or with
immunohistological reactions like GFAP, Vimentin).
Glib +
Glib ++
Glib +++
41. Honeycomb-like cells: The tumor
cells show intracytoplasmatic vacuolar changes and a central the nuclei. 
Hone + Hone ++ Hone +++
42. Presence of
oligodendroglial cells: Intratumoral clearly
identified oligodendrocytes (with special histologic methods or with
immunohistological reactions like GFAP, Vimentin and other methods).
Normal oligodendroglia cells of the whit matter
Normal adult Oligodendrolgial cells of the cortex.
Olig +
Olig ++
Olig +++
43. Presence of macrophages and microglial cells:
Intratumoral clearly identified macrophages and/or microglial cells (with special
histologic methods or with immunohistological reactions like Vimentin, CD-68 and
others).
Macr + Macr ++ Macr +++
44. Presence of
undifferentiated cells: Quantity of non-classified tumor cells also after the use
of specific histological or immunohistological techniques.
Undi + Undi ++ Undi +++
Un1: Unknown papillary tumor; Un2: Immunohistological differentiated; Un3: Non-differentiated cells also after immunohistological methods.
45. Non-brain cells: Presence of clearly identified non-brain cells, epithelial or carcinoma cells.
Non + Non ++ Non +++
46. Vacuolization: Intra- or extra
cellular vacuolization into the tumor tissue.
Vacu + Vacu ++ Vacu +++
47. Wide collagen bundles: Presence of isolated
collagen fibers o bundles of collagen fibers.
Coll + Coll ++ Col +++
48. Presence
of myelin: Quantity of myelin fibers between the tumor cells
studied with special histologic techniques or with immunohistological methods.
Mye + Mye++ Mye +++
49. Prominent nucleoli: Into the nucleus of the tumor cells more or less
prominent nucleolus are shown.
Prnu + Prnu ++ Prnu +++
50. Tumor infiltration of the meninges: Clearly
identified tumor infiltration along of the arachnoidea, but not of the dura mater.
Meni + Meni ++ Meni +++ _____________________________________________________
Since many years we make use of a formular to study an to note the more important histological and immunohistological features of all tumors the central and periheral nervosus tissue.
Not only histological but macroscopical carachteritics, age, gender and diagnosis were also noted. All features were coded. This sistematic and computerized method can offer greater objectivity and thus could leas to a unification o criteria. This method allowed us to analyse in detail which characteristics changes in the different diagnoses and in the different degree of malignity and also allowed to correlate the phenotypic variability of the different tumors with the results of the genetic studies.
