The 59-year-old woman visited our hospital in ambulance because of drowsiness and nausea, Plain CT scan demonstrated mass lesion in the left occipito-parietal region accompanied with hemorrhage and rupture to the ventricle. Chest radiograph showed multiple mass lesions in bilateral lung fields. T1-weighted MR image of the pelvis after administration of contrast medium showed multiple heterogeneously enhanced mass lesions adjacent to the right femur. After the admission her consciousness level was going down day by day and then the emergent operation of resection of brain tumor was done. Histologically the brain tumor showed quite compact cellular feature with hemorrhage that was composed of large cells with vesicular nuclei, prominent nucleoli, frequent mitotic figures and deeply eosinophilic cytoplasm. Some of the tumor cells had glassy cytoplasmic inclusion bodies, indicating rhabdoid feature. Then, the differential diagnoses of the brain tumor were extrarenal malignant rhabdoid tumor, epithelioid sarcoma(proximal type), synovial sarcoma, malignant mesothelioma, extraskeletal myxoid chondrosaroma and so on. Thereafter, the biopsy of the tumor of the right thigh was done. The histology showed characteristic nodular configuration in which short anastmosing cords of eosinophilic tumor cells are deposited in abundant myxoid stroma. This lesion was diagnosed as extraskeletal myxoid chondrosarcoma and considered as the primary lesion and to be metastasized to the brain through the lung with dedifferentiation.

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The median survival of malignant gliomas is less than 1 year even with aggressive treatment using surgery, radiation and chemotherapy.
The reason why the surgical therapy is incurable are 1) the origin of gliomas is neural stem cells in the subventricular zone; 2) they can migrate everywhere in the brain along with white matter and basement membrane. The significance of operation is to diagnose the histology, gene profiling and sensitivity to radiation and chemotherapy in the purpose of lengthening progression free survival and maintaining quality of life.

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The electron microscopy has played an important role for the diagnosis of the brain tumors and the establishment of new entities and variants of them. However, the chance of ultrastructural analysis has decreased with the advent of immunohistochemistry. I present my personal experiences and view on the diagnosis of brain tumors.

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WHO grade in meningiomas is useful for predicting recurrences. However, some of grade 1 meningioma can recur after total removal. I have examined the utility of several histological parameters for the prediction of a recurrence in benign meningiomas. Benign meningiomas rarely possessed some of histological features that were characteristic to high-grade tumors. That is, features of necrosis, brain invasion, prominent nucleoli, and small cell aggregation were rare, and those factors could not employed to distinguish recurrent and non-recurrent tumors in grade 1 meningiomas. In univariate analysis, cellularity, calcification, mitotic figures and MIB-1value (>2.0%) were signrificantly related to recurrence. In multivariate analysis, only MIB-1 value and calcification were significant. In recurrent benign meningiomas, MIB-1 value tended to decrease at the second surgery when MIB-1 value at the first operation was lower than 2.0%. The biological activity of meningiomas might be different between tumors with MIB-1 value less than 2.0% and those with higher MIB-1 value.

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Although giant cells are often picked up in various brain tumors, the giant cell brain tumor is defined as giant cells inhabit the majority of the brain tumor. In clinical brain tumor pathology, giant cell brain tumors are diagnosed occasionally including giant cell glioblastoma and subependymal giant cell astrocytoma derived from neuronal epithelium, and giant cell tumor of bone derived from skull. In this study,5 cases of giant cell brain tumors including 2 cases of giant cell glioblastomas,2 cases of subependymal giant cell astrocytomas and one case of giant cell tumor of bone were investigated to observe the features of the giant cells in the brain tumors by optical microscope, immunohistochemistry and electron microscope. The results demonstrated that the largest average area of the giant cell were observed in the case of giant cell glioblastoma, and the smallest average area of the giant cell were observed in the case of subependymal giant cell astrocytoma, and the giant cell hold the most nucleus in the giant cell tumor of bone. Our data suggest that giant cells present respective characteristics in different giant cell brain tumors.

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