Recurrence in medulloblastoma – Influence of clinical, histological and immunohistochemical factors

Abstract

Introduction. The therapy for medulloblastomas has gone through several changes over the years. Research has shown that patients with medulloblastoma cannot be satisfactorily stratified into risk groups based on clinical and therapeutic factors alone.

Aim. To study the clinical, histological features and expression of immunohistochemical markers in medulloblastoma, and to correlate these features with recurrence rates.

Materials and methods. Sixty-three cases of medulloblastomas operated at our institute from 1996–2003 were selected and retrospectively analyzed for therapy received, histological features and immunohistochemical expression of GFAP, synaptophysin, erb B2, p53, Bcl-2 and Trk-C along with assessment of MIB-1 labeling index(LI).

Results. The mean age of the 63 cases at presentation was 11.6 yrs. Near/Gross- total resection was achieved in 74.6% (47/63) of the cases.

Conclusion. We propose a clinical-histological-immunohistochemical’ model for medulloblastoma where extent of resection, administration of chemotherapy, presence of gross anaplasia and c-erb B2 overexpression status are the most important predictors of recurrence rates.

Key words:

• Anaplasia
• c-erb B2
• ‘clinical-histological-immunohistochemical’ model
• Histopathological subtype
• Immunohistochemical factors
• Medulloblastoma
• Recurrence

Acknowledgements

We sincerely thank Mr. Balaram Thota, Ms. Vrinda Marigowda, Mrs. Shilpa Mayagowda and Mr. K. Prem for their valuable help in immunohistochemical staining of the slides.

Dr. Umesh Srikantha has been involved in data collection, statistical analysis and preparation of the manuscript. Dr. Anandh Balasubramaniam and Dr. Sampath Somanna have been involved in giving valuable suggestions and modification of the manuscript. Dr. Vani Santosh has been involved in conception of the work, interpreting histology and IHC slides, and manuscript corrections. Dr. Indira Devi and Dr. BA Chandramouli have given valuable inputs in conceptualizing the work, and manuscript preparation.

Declaration of interest: The authors report no sources of funding nor any conflicts of interest. The authors alone are responsible for the content and writing of the paper.