MIB1 and p53 immunoreactivity in protoplasmic astrocytomas.

Pure protoplasmic astrocytomas are a group of rarely encountered low grade astrocytic neoplasms. Relatively few studies have specifically examined this subset of tumors. A series of 18 protoplasmic astrocytomas in 14 males and four females (age range 2.5-52, mean 22 years) were studied in order to examine MIB1 (a marker of cell proliferation) and p53 (a tumor suppressor gene) immunoreactivity. All patients presented with seizures (mean duration 94 months) and three with headaches also. Eight tumors were located in the temporal lobe and six in the frontal lobe. All tumors were characterized by a proliferation of astrocytes with round nuclear contours arranged against a microcystic background. Only rare foci of mild vascular proliferation (3 tumors), rare mitotic figures (1 tumor), and mild nuclear atypia (3 tumors) were observed. Most tumors were primarily cortical in location. Necrosis was not seen in any of the tumors. MIB1 indices (number of MIB1 positive tumor cells/1000 tumor cells evaluated x 100) ranged from 0 to 4.3 (mean 0.7); in five tumors, no MIB1 staining was observed. p53 immunoreactivity was noted in 5 of 18 tumors (28%). Five patients received adjuvant radiation therapy and one adjuvant chemotherapy. At last known follow-up, 11 patients are alive with no evidence of residual tumor (mean 70 months), six patients are alive with evidence of residual tumor (mean 58 months), and one patient died of complications unrelated to the tumor (36 months) postoperatively. Based on these findings, the conclusions presented are as follows: (i) MIB1 indices are generally low in these tumors, corroborating the clinical impression of a slow growing neoplasm; and (ii) p53 immunoreactivity is observed in a minority of protoplasmic astrocytomas.