Pale islands in medulloblastoma consist of differentiated cells with low growth potential

Cerebellar medulloblastomas are the most common embryonal neoplasms occurring in the pediatric age group. Thirty-five specimens from 28 cases of medulloblastoma and variant neoplasms were examined to elucidate the histopathologic significance of the reticulin-free pale islands. In 10 specimens, there were light-looking areas corresponding to pale islands: three specimens from desmoplastic and seven from classic medulloblastoma. The difference in cell population, 1.73-fold more cells in dark areas than in light areas (P < 0.001), seemed to be a major factor in the formation of the biphasic architecture. Immunohistochemically, occasional tumor cells in both areas were found to express neuronal phenotypes. In addition, positive immunoreactivity for glial markers was exceptional. There was significant difference in the staining indices (SI) for cell proliferation markers. The light areas consistently showed low SI values (mean MIB-1 SI, 5.75; mean PCNA SI, 11.8) compared with the dark areas (mean MIB-1 SI, 22.7; mean PCNA SI, 44.9). It is suggested that light areas (pale islands) consist of more differentiated cells of neuronal lineage with relatively low proliferation potential. These tumor cells might proliferate in a group, and then expand, thereby compressing the surrounding tissue to form pale islands.