Immunohistochemical and ultrastructural observations on homer wright (neuroblastic) rosettes and the “pale islands” of human cerebellar medulloblastomas

A combined immunohistochemical and ultrastructural study of20 cerebellar medulloblastomas has demonstrated features of early neuronal differentiation. The differentiation features are primarily encountered in the Homer Wright rosettes and in the reticulin-free “pale islands,” or “follicles,” of the desmoplastic variant. They consist of parallel arrays of aggregated neurite-like processes containing longitudinally oriented microtubules (immunoreactive for polyvalent antisera to tubulin and γ-enolase, but nonreactive for a monoclonal antibody to the 150/200 kD subunits of neurofilament protein) and junctional adhesion plaques. We consider the inherent property of self-aggregation of the neurite-like processes with adhesion plaques a significant mechanism in the formation of Homer Wright rosettes. Further differentiation and elongation of these cell processes may lead to the formation of “pale islands” in the desmoplastic medulloblastoma. A meshwork of astroglial cells, coexpressing glial fibrillary acidic protein and S-100 protein immunoreactivity, forms an integral part of the “pale island.” The histogenetic significance of these astrocytes and their relationship to tumor cells expressing early neuronal differentiation remains to be defined.