Computed tomographic and histopathological studies of pontine glioma

Correlative study of computed tomography (CT) and pathologic findings was performed in eight cases of pontine glioma. All patients except one had chemotherapy and radiotherapy, with no surgical intervention. On initial CT scans, all patients had hypodense lesions in part or the whole of the pons, and there was evidence of mass effect. Four of eight cases showed contrast enhancement. After chemotherapy and radiotherapy, swelling of the pons and the width of the hypodense areas decreased. The hypodense areas sometimes became isodense in correlation with clinical amelioration. After several months of remission in responding cases, ring-enhanced lesions reappeared at the primary site, together with recurrent neurological signs. Pathological study postmortem was focused on the histological counterparts of the CT findings of central and perifocal hypodense areas and contrast enhancement. In six of seven treated cases, the central hypodense area surrounded by ring enhancement was shown to be coagulation necrosis. Higher cellularity and hypervascularity with glomeruluslike structures of small vessels were generally observed in enhanced areas. The areas diffusely infiltrated by tumor cells, but not enhanced in CT scans, had few abnormal vessels. Tumor cells were seen not only in hypodense areas around the enhanced portion but also in areas far beyond the enhanced portion. Exophytic expansion of tumor was observed in two cases on postmortem examination. One of these was detected by CT scans before death.