Case Of Ganglioglioma Research Articles

Multimodal neuroimaging verification of ganglioglioma associated with neuronal heterotopy in an adult patient without epileps

Gangliogliomas are known to be rare and mainly slow-growing benign primary central nervous system tumors, most frequently occurring in children and young adults. They are the most common epilepsy-associated tumors, which frequent location is the temporal lobe. Surgery often seems to be the best approach in controlling seizures in such patients. This paper deals with a rare case of ganglioglioma in a young adult patient with a temporal lobe tumor associated with neuronal heterotopy of white matter, but without epilepsy. Long-term dynamic observation including in-depth clinical, electroencephalographic, radiologic, and postsurgical histologic examination confirmed the documented neoplastic process without any manifestation of seizures over ten years. Surgical intervention was based on the results of a multimodal radiological examination, which demonstrated the presence of neoplasm in the structure of the pathological substrate of unclear etiology.

A Cross Sectional Study of Clinical and Histopathological Spectrum of Pediatric Brain Tumours

Introduction: Brain tumors are the most common tumor of the childhood and the second most common malignancies after haematological malignancies. Childhood central nervous system (CNS) tumors differ significantly from adult brain tumors in reference to their sites of origin, clinical presentation, tendency to disseminate early, histological features and their biological behaviour. Aims and Objective: Analyse the Clinical and histopathological spectrum of brain tumors, in pediatric patients ≤18 year of age. Materials and Method: This was a cross sectional study conducted at the department of pathology, SMS medical college, Jaipur from January 2020 to October 2021. This is a laboratory based descriptive type of observational study and data of brain tumors in children equal or less than 18 year of age procured and their clinico-histopathological spectrum were analyszed. Result: In our study, Out of 116 patients 51.8 % were male and 48.2 % were female. Mean age for the male cases were 10.11 and for female cases were 9.78. we observed intracranial pediatric tumors 67 cases (57.7%) were located in infratentorial region and 49 cases (43.3%) were located in supratentorial region and incidence for intracranial tumor was 39(33.62%) cases of astrocytomas followed by 25 (21.55%)cases of medulloblastoma, 20 (17.24%)cases of ependymoma, 13 (11.20%) cases of craniopharyngioma, 5 (4.31%) cases of pituitary adenoma, 4 (3.44%) cases of meningioma, 3 (2.58%) cases of embryonal and choroid plexus tumor, 2 (1.72%) cases of ganglioglioma and 1 (0.86%) case of Schwannoma and PNET. In this article, Based on tumor location, the symptoms of CNS tumors on the supratentorial region were headache (22 cases, 44.8%), impaired vision (10 cases, 20.4%), seizures (6 cases, 12.2%), vomiting (4 cases, 8.1%). Symptoms of CNS tumors on the infratentorial region were headache (48 cases, 71.6%), vomiting (5 cases, 7.4%), impaired vision (4 cases, 5.9%), seizures (3 cases, 4.4%). Conclusion: Infratentorial cases, maximum number of cases were medulloblastomas and supratentorial cases, maximum number of cases were astrocytic tumours. Overall astrocytic tumours in all senses constituted the most common group of CNS tumours. Within astrocytoma, low grade astrocytoma (grade I & II) was most common CNS paediatric tumour.

Our Experience of Posterior Fossa Tumors Surgeries

Objective: In Neurosurgery Unit III, Punjab Institute of Neurosciences, Lahore, we evaluated our posterior fossa tumor surgery results, complications, and surgical outcomes.
 Materials and Methods: Between January 2017 and September 2021, 80 patients with posterior fossa tumors who underwent surgical excision at the Neurosurgery Department-III of the Punjab Institute of Neurosciences in Lahore were studied retrospectively. For each patient, the diagnosis was made clinically and confirmed radiologically and histopathologically.
 Results: Males comprised 47 percent (37) of the 80 cases, while females made up 53 percent (43). The average age was 15 (with a range of 6 – 30 years). Medulloblastomas were the most frequent pathology in 25 patients (31%), followed by ependymomas in 21 patients (26%), pilocytic astrocytomas in 19 patients (24%), and hemangioblastomas in 7 individuals (8.8%). There were four cases of metastatic brain cancers (5%), two cases of choroid plexus papilloma (2.5%), one case of ganglioglioma (1.3%), and one case of Dermoid cyst (1.3%). In 90 percent of the cases (72 cases), gross total resection was obtained, while subtotal excision was performed in 10% of the cases (8 cases). The best results were seen in pilocytic astrocytoma surgery, followed by ependymoma surgery, whereas the worst results were seen in medulloblastoma surgery.
 Conclusion: The surgical treatment of posterior fossa tumors still poses a significant challenge to neurosurgeons. Our experience shows that accepted results, complications, and surgical outcomes can be obtained by meticulous surgical techniques from previous clinical studies.

GENE-30. PRELIMINARY STUDY ON WHOLE-EXOME SEQUENCING TECHNOLOGY IN THE GENETIC ANALYSIS OF PEDIATRIC PATIENTS WITH GLIOMAS

Abstract OBJECTIVE To analyze the genes related to the signaling pathways in pediatric gliomas and drug-related genes with whole-exome sequencing technology. METHODS The tumor tissues and matched blood samples of 17 enrolled patients were detected with whole-exome sequencing technology. There were 3 cases of diffuse midline gliomas, 2 cases of childhood glioblastomas, 3 cases of disffuse astrocytoma, 1 case of pleomorphic xanthoastrocytoma, 1 case of ganglioglioma, 6 cases of anaplastic ependymoma and 1 case of ependymoma in this study. All the enrolled patients who were no more than 14 years old received surgery in the Department of Neurosurgery, Guangdong Sanjiu Brain Hospital. The diagnosis was confirmed by pathological examination and the sample acquisition was approved by hospital ethics committee. RESULTS With the use of whole-exome sequencing technology, a total of 31 related genetic mutations were detected in 15 cases, while no genetic mutation was detected in the other 2 cases. The genes related to the signaling pathways in pediatric gliomas included ATRX, ASL1, BCOR, EP300, FGFR1, H3F3A, IGF1R, MED12, PIK3R1, PRKDC, RB1, SETD2, SMARCA4, SOX2, TGFBR2, and the drug-related genes included AKT1, BCL2, BRAF, BRCA2, CCND1, CCND2, CDK6, EGFR, FGF3, KRAS, MET, PDGFRA, PIK3CA, PTEN, TP53, TSC1. One patient only had genes related to the signaling pathways, and 14 patients had drug-related genes. CONCLUSION Applying whole-exome sequencing technology in the genetic analysis of pediatric patients with gliomas has remarkable guiding significance for revealing the mechanism of disease, searching for therapeutic targets and adopting individualized treatment, which can bring potential benefits to pediatric patients. However, more samples and further data analysis and verification are needed in future study.

Surgical treatment of low grade brain tumors associated with epilepsy in children

Objective To explore the strategy of surgical treatment for children with low-grade tumors associated with epilepsy. Methods Clinical data of 30 patients with low grade tumors (ages: 1-14 years) were retrospectively reviewed who underwent surgery from January 2011 to June 2016 at Department of Neurosurgery, Guangdong Sanjiu Brain Hospital. Lesions were located in multiple cerebral lobes in 8 cases, in functional zones in 8 and in non-functional zones in 14 cases (including 10 cases with lesions in the medial temporal lobe). The surgical strategy included subtotal resection, gross-total resection and enlarged resection. Postoperative effects were evaluated by Engel classification. Results A total of 30 patients underwent surgical treatment. Subtotal resection was achieved in 8 cases, gross-total resection in 5 and enlarged resection in 17 (including 9 cases undergoing anterior temporal lobectomy and 1 case of selective amygdalohippocampectomy). The final pathology suggested that there were 11 cases of ganglioglioma, 8 cases of dysembryoplastic neuroepithelial tumor, 2 cases of pilocytic astrocytoma, 3 cases of oligodendroglioma, 3 cases of pleomorphic xanthoastrocytoma, 1 case of diffuse astrocytoma , 1 case of oligoastrocytoma and 1 case of meningioma. The follow-up duration was 1-6 years, with an average of 3.0±1.6 years. For postoperative recover: 28 cases had an outcome of Engel Class I, 1 patient was in Engel Class Ⅱ and 1 patient was in Class Ⅳ. Conclusions For surgical treatment for children with low-grade tumors associated with epilepsy, more attention should be paid to preoperative assessment of the epileptogenic zone. The tumor is not exactly the same as the epileptogenic zone and the strategy of surgical treatment depends on the tumor characteristics as well as whether it is located at temporal lobe or involved in functional areas. Key words: Epilepsy; Child; Brain neoplasms; Low grade; Neurosurgical procedures

Intraventricular ganglioglioma with extensive hemorrhage.

Gangliogliomas represent a rare form of neuroepithelial tumor (up to 1.3% of brain tumors [<xref-ref>1</xref-ref>]), which even more rarely present with hemorrhage or localize intraventricularly. To date, only two cases of ganglioglioma with both of these features have been reported. Our patient is a 23-year-old woman who presented with signs and symptoms of increased intracranial pressure (ICPI), with a post-subtotal resection diagnosis of WHO Grade I ganglioglioma localizing bilaterally to the lateral ventricles. One year following the operation, the tumor showed radiologic evidence of interval hemorrhage, which was verified histopathologically following a second subtotal resection. Greater than 95% of the lesion represented a large hematoma with organization and well-defined fibrous pseudo-capsule, with very scanty fragments of adjacent/peripheral low-grade neuroglial tumor. This case represents a very rare presentation of intraventricular ganglioglioma with extensive hemorrhage. .

ED-39 * GANGLIOGLIOMA IN CHILDREN; IDENTIFICATION OF CASES AT RISK OF DEATH DUE TO PROGRESSION FOLLOWING INITIAL SURGERY

Gangliogliomas have traditionally been considered benign tumors, particularly in children. Following resection, the prognosis is thought to be excellent. We reviewed all cases of ganglioglioma at our institution over the preceding 10 years. Cases were identified by a review of the Neuro-Pathology records. Clinical and radiographic information was generated by a retrospective review of charts by the Dept. of Neuro-Oncology. 40 cases occurred in those age 25% by immunohistochemistry (IHC); this was present in 3/9 cases checked in those who did not die (p < 0.05). Conclusion: While generally benign tumors, we suggest close surveillance in children with the following characteristics: biopsy alone undertaken, histological features of JPA or anaplasia and a high p53 by IHC.

Oligodendroglial ganglioglioma

Gangliogliomas are rare tumors of the central nervous system, usually containing neoplastic ganglion cells and astrocytic components. Few cases of ganglioglioma containing only oligodendrocytic tissue have been reported to date. We present a case of a 40-year-old woman with ganglioglioma consisting mostly of oligodendroglial components. Magnetic resonance imaging showed a well-demarcated cystic lesion with slight perifocal edema in the right parietal lobe. The wall of the cyst was not enhanced after administration of Gd-DTPA contrast media. The mass was totally resected. Histological examination showed a mixture of two distinct components: oligodendroglioma and dysplastic ganglions. The first component was diffusely proliferated cells with round nuclei and perinuclear halo; the second showed marked nucleoli and basophilic cytoplasm containing Nissl bodies. Immunohistochemical study of the oligodendroglial component was positive for OLIG 2 and NKX2.2 but negative for synaptophysin. In addition, LOH of 1p/19q was detected by FISH. Although no adjuvant therapy was carried out, follow-up MRI showed no recurrence of the tumor 41months after the operation.

The pathological features of ganglioglioma with tanycytic ependymoma as the glial component

Objective To explore the pathological features of ganglioglioma with tanycytic ependymoma as the glial component. Methods One case of ganglioglioma was studied by paraffin slices, HE staining, immunohistochemistry markers and observed under microscopy. Results A 21 ⁃ year ⁃ old woman mainly presented with intermittent physical convulsion and dizziness. Magnetic resonance imaging (MRI) demonstrated an occupying lesion in right parietal lobe. It was seen in the operation that the tumor was located in right parietal lobe. The tumor measuring about 4.50 cm × 4.00 cm × 4.00 cm was tenacious and grey⁃red in color. The blood supply was general. Most parts of the tumor boundary were clear. After removing the tumor, it was found that the operated cavity was communicated with lateral ventricle. Under microscope it was seen that the tumor was composed of tumorous glial cells and gangliocytes. The glial components were tanycytic ependymoma cells and glial cells arranged in a spreading bundle pattern. Perivascular pseudorosettes could be seen in the tumor. The distribution of gangliocytes was not uiform. Most gangliocytes were well⁃differentiated. Immunohistochemistry showed that tanycytic ependymoma cells were reactive with antibodies of glial fibrillary acidic protein (GFAP), vimentin (Vim) and epithelial membrane antigen (EMA), while gangliocytes were reactive with antibodies of neuronal nuclei (NeuN) and neurofilament protein (NF). Conclusion Ganglioglioma is a kind of rare tumor originated from neurepithelium. It is well⁃differentiated and retardation in growth. It is composed of tumorous glial cells and gangliocytes. The most tumorous glial components are astrocytes. Ganglioglioma with tanycytic ependymoma as the glial component is very rare. Grasping the tumor pathological features is useful in the diagnosis and treatment of this disease. DOI：10.3969/j.issn.1672-6731.2011.03.018

Ganglioglioma Associated with Cerebral Cortical Dysplasia: An Unusual Case with Extensive Leptomeningeal Involvement

Ganglioglioma is a tumor occurring in children and young adults and characterized by a superficial cortical location and biphasic histologic differentiation encompassing neuronal and glial elements. Ganglioglioma may arise anywhere throughout the neuraxis, including the optic nerve, brain stem, pineal gland, cerebellum, cerebrum, and spinal cord; however, the majority of glioneuronal neoplasms involve the temporal lobe. Gangliogliomas may show focal leptomeningeal involvement, but predominant leptomeningeal involvement by gangliogliomas is extremely rare; only 2 cases of ganglioglioma extensively involving the leptomeninges have been reported. In this report, we present an unusual case of a ganglioglioma predominantly present within the leptomeninges of a 15-year-old boy with a history of seizures. Furthermore, the cerebral cortex beneath the tumor showed dysplastic changes. We report a very unusual case of ganglioglioma involving predominantly the cerebral leptomeninges and associated with adjacent cerebral cortical dysplasia. Histologic characteristics and diagnostic pitfalls are discussed.

Expression of drug resistance-associated proteins in brain of patients with refractory epilepsy

To study the expression of P-glycoprotein, multi-drug resistance associated protein and major vault protein in pathologic brain specimens, and to investigate their roles in the pathogenesis of refractory epilepsy. Immunohistochemical study was performed in pathology specimens from 18 cases of refractory epilepsy (including 5 cases of focal cortical dysplasia, 3 cases of tuberous sclerosis, 5 cases of ganglioglioma and 5 cases of dysembryoplastic neuroepithelial tumor). Both the P-glycoprotein and major vault protein were localized in microvascular endothelium of the lesions. Major vault protein was also seen in balloon cells and some neuronal cells. On the other hand, multi-drug resistance associated protein was mainly localized in the neuronal component of the lesions. In general, the expression of P-glycoprotein and major vault protein in tumoral tissue was higher than that in non-tumoral tissue. The expression of multi-drug resistance associated protein and major vault protein was also different in the neoplastic glial cells of ganglioglioma and dysembryoplastic neuroepithelial tumor. P-glycoprotein, multi-drug resistance associated protein and major vault protein contribute to the pathogenesis of refractory epilepsy. They may however have different roles, with different cellular localization.

Ganglioglioma in the third ventricle: report on two cases

Gangliogliomas are uncommon central nervous system (CNS) tumors composed of a mixture of glial and neuronal elements. Although these tumors can occur in any portion of the central nervous system, involvement of the ventricular system is rare. We herein report on two cases of gangliogliomas in the third ventricle in a 34-year-old woman and in a 52-year-old man. One patient presented only with headaches, and the other presented symptoms associated with panhypopituitarism and diabetes insipidus. In the first case the tumor in the middle portion of the third ventricle was successfully removed by a transcallosal subchoroidal approach. In the second case the hemorrhagic tumor was located in the anterior floor of the third ventricle and was removed by an anterior inter-hemispheric trans-lamina terminalis approach. To date, follow-ups of both patients have involved no adjuvant therapy, and there have been no signs of tumor recurrence on magnetic resonance images. The nature, radiological findings, and treatments of these tumors are discussed.

Ganglioglioma occurring with glioblastoma multiforme: Separate lesions or the same lesion?

The authors report on the first such case of ganglioglioma and a malignant variant in the same individual without prior irradiation. Gangliogliomas are frequently encountered in children and young adults and have a predilection for the temporal lobes. Sporadic cases of malignant degeneration have been reported; however, most cases have undergone radiation or subtotal resection. A 45-year-old female was seen for speech abnormalities and symptoms referable to elevated intracranial pressure. The patient had no significant past medical history and no history of neurocutaneous disorders. Two separate lesions located in the posterior and anterior temporal lobes were found on imaging. At initial surgery, she underwent gross total resection of the anterior temporal tip ganglioglioma and cyst aspiration of the posterior temporal lobe lesion. The anterior temporal lesion was a ganglioglioma and did not recur. However, the posterior temporal lesion was identified as a malignant ganglioglioma/glioblastoma multiforme variant that recurred multiple times requiring several surgeries, radiation and chemotherapy. The occurrence of these distinct entities is uncommon in patients without a history of prior radiation treatment. Even rarer, is the occurrence of these separate intracranial lesions in a patient without a history of phacomatosis. For benign gangliogliomas, gross total resection can be curative; however, more aggressive variants may be resistant to multimodal therapies.

Molecular genetic studies on ganglioglioma

To study the genetic alterations of ganglioglioma through the entire genome, and to investigate the pathogenesis of this neoplasm. Comparative genomic hybridization was used to provide an overview of genetic abnormalities in gangliogliomas. Five cases of gangliogliomas, including 3 males and 2 females, were studied genetically. Loss of genetic materials on the short arm of chromosome 9(9p) was a common genetic alteration found in 3 of 5 cases. Overrepresentation of chromosome 7 was another recurrent chromosomal imbalance, which was further confirmed by fluorescence in situ hybridization. Immunohistochemical analysis was performed on epidermal growth factor receptor (EGFR), which was located on 7p11-p13. All five cases revealed no abnormal expression of EGFR. On the other hand, genetic imbalances were also involved in multiple chromosomes including 2q33-q34, 8q12-q22, 14q21-qter, 15q26-qter and Y. Loss of genetic materials on chromosome 9p and gain on chromosome 7 may be associated with the pathogenesis of this neoplasm.

Genome-wide survey for chromosomal imbalances in ganglioglioma using comparative genomic hybridization

Ganglioglioma is a mixed neuronal and glial tumor first described by Perkin in 1926. Because of its rare occurrence in the central nervous system, the pathogenesis of this neoplasm is still largely unknown. Previous studies of ganglioglioma mainly focused on histologic features, immunohistochemical analysis, clinical treatment, and patient outcome. Very few cytogenetic and molecular genetic studies have been reported on this neoplasm. To better understand the mechanism underlying the development of ganglioglioma, we performed comparative genomic hybridization analysis to investigate chromosomal imbalances across the entire genome in five cases of gangliogliomas. Loss of genetic material on the short arm of chromosome 9 was a common genetic alteration found in three of five cases. Overrepresentation of partial or the whole chromosome 7 was another recurrent chromosomal imbalance, confirmed by fluorescence in situ hybridization. Immunohistochemical analysis was performed; all five cases revealed no reaction or low expression for epidermal growth factor receptor antibody. Our study highlights chromosomal regions for further fine mapping and investigation of candidate tumor suppressor genes involved in the pathogenesis of ganglioglioma.

Clinical characteristics and surgical outcome of patients with temporal lobe tumors and epilepsy.

This is a retrospective study of 21 surgically treated patients with temporal lobe tumors and epilepsy. Evaluation included clinical data, EEG findings, structural scans, pathological diagnosis and post-surgical follow-up. There were 9 cases of ganglioglioma, 5 pilocytic astrocytoma, 3 ganglioneuroma, 2 dysembryoplastic neuroepithelial tumor, 1 pleomorphic xantoastrocytoma, and 1 meningioangiomatosis. Mean follow-up time was 22 months and outcome was evaluated according to Engel's classification; 76.2% were classified in class I and 23.8% in II and III. All patients classes II and III had been submitted to mesial and neocortical resections. There were no differences related to clinical characteristics, pathological diagnosis or duration of follow-up in patients seizure-free or not. All patients had abnormal MRI and ten of these had normal CT; the MRI characteristics were compared to pathological diagnosis and specific histological characteristics of the tumors were not discernible by MRI. We concluded that MRI was essential for the diagnosis and precise location of TL tumors. Ganglioglioma was the most frequent tumor and lesionectomy associated to mesial resection doesn't guarantee a better prognosis.

Ultrastructural alterations of neuronal cells in gangliogliomas

Gangliogliomas are uncommon glioma of the central nervous system, generally found in the temporal lobe of young individuals with a clinical history of seizures. The tumor is a mixed tumor composed of neoplastic mature ganglion cells and neoplastic glial cells, mostly astrocytes. Although the clinicopathological correlation of this tumor is well documented, few detailed ultrastructural studies have been reported.We studied three cases of ganglioglioma of the temporal lobe and found several unusual ultrastructural features of the neuronal cells: (1) Hirano bodies (eosinophilic rod-like structure), highly organized eosinophilic crystalloid arrays of interlocking filaments that display lattice like configuration. Homogenous electron-dense material may appear as patches permeating the fibrillar structure (Fig. 1). (2) Lafora bodies (polyglucosan bodies), round to oval non-membrane-bound inclusion composed of short branching filaments about 7-10nm in diameter and granular structures (Fig. 2). (3) Pick's bodies, perikaryonal aggregates of straight neurofilaments with or without ribosome association mixed with vesicles, myelin figures and dense bodies.

Ganglioglioma of the spinal cord

A case of ganglioglioma or neuroastrocytoma of the spinal cord in a 78-year-old man is reported. Diagnosis was based on the histological identification of the neoplastic cells and on the study of the architecture of the tumour. The presence of cellular anaplasia, sometimes of marked degree, and of small nests of infiltration suggested an initial malignant behaviour regarding both cellular types. A survey of the five reported cases of spinal ganglioglioma is presented.

Pathological analysis of intracranial space-occupying lesions in 1000 cases including children: Part 2. Incidence, types and unusual cases of glioma

1. (1) In continuation of our first paper ( Dastur et al. 1968) on the overall analysis of 1000 intracranial space-occupying lesions, this paper analyses in detail 370 gliomas which constituted 37.1% of the former but 48.2% of the 768 true neoplasms in this series. The average age for gliomas was 27 years, much younger than that of any reported series. 2. (2) Astrocytomas comprise 60.5% of gliomas. They have been classified into grades I, II, III and IV according to the degree of cellular anaplasia (Kernohan's method). Benign astrocytomas (grades I and II together) comprise 39.3% and the malignant (grades III and IV together) 60.7%. The average age for the former was 26 years, for the latter 35 years, and for the whole group 31.5 years. 3. (3) Of the total number of gliomas 27.3% (101) occurred in children under 15 years of age, a figure comparable with Japanese data but much higher than the figures reported from the West. Of these 41.5% were astrocytomas, of which nearly 70% were benign in contrast to 39% in the total material. Similarly, while two-thirds of all the total gliomas were supratentorial, two-thirds of the gliomas in childhood were infratentorial. Cerebellar astrocytoma was mainly responsible for these two features. 4. (4) Vascular and perivascular changes in astrocytomas were stressed and a case of combined astrocytoma and vascular sarcoma is described. The youngest age at onset (4 years) and longest survival (4 years) were observed in a boy with malignant astrocytoma. 5. (5) Ependymomas constituted the second most frequent type of glial tumour in both our total (14%) and paediatric (24%) material, being comparable to the incidence in Japan; but the proportion of our fourth ventricular ependymomas in children was higher than in Japan, and much higher than in any Western series. 6. (6) The medulloblastomas, almost equalling the proportion of ependymomas among children, were divided into the 3 histological subtypes of classical (49%), transitional (24%) and desmoplastic (27%) tumours. There was no significant age difference between the former, and the latter which was characterised by hemispheric location, surface extension and profuse reticulin in the fibroblastic part of the tumour. The histogenesis of the medulloblastoma is discussed. 7. (7) The optic nerve gliomas and neuro-hypophyseal gliomas were characterised by a common pattern of piloid astrocytoma. The former were all seen in children. The 4 latter constituted an unusually large proportion (1.1%) and occurred at all ages, and 1 of them showed excessive Rosenthal bodies. 8. (8) Four of the 7 pineal tumours appeared gliomatous with the pattern either of a pineocytoma or pineoblastoma. They are not very frequent tumours, thus contrasting with the findings in Japan. 9. (9) The choroid plexus papilloma also appears to be a tumour of childhood. One case with anaplastic change is described. 10. (10) Two cases of ganglioglioma were found. Both were seen in children, and were slow-growing, with astrocytic elements predominating. One case showed oligodendroglia and calcospherites. 11. (11) A most unusual medullo-epithelioma with a rich fibrovascular stroma is described. 12. (12) The effect of X-irradiation on a glioma is demonstrated through an unusual case of olfactory neuroblastoma which showed extensions into the frontal lobes and the naso-pharynx. An ependymoma operated on four times is also described to show the lack of cellular and nuclear outline which may result from irradiation. 13. (13) Cerebral reticulosis with its typical large mononuclear cells and cellular reticulin is demonstrated through the oldest case of our series, a man aged 76 years.

GANGLIOGLIOMA

A case of ganglioglioma is described, in which anaplastic change of its astrocytic component into a glioblastoma multiforme took place 23 years after the original biopsy. The original ganglionic tumor was readily identified at necropsy. The neurons played no part in this malignant evolution of the growth.