Histopathologic features of composite ganglioneuroblastoma. Immunohistochemical distinction of the stromal component is related to prognosis

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Abstract
Histopathologic features of 18 cases of composite ganglioneuroblastoma (CGNB) were studied with immunohistochemical staining techniques using antibodies against S‐100 protein (S‐100), ferritin (FER), and leukocytic common antigen (LCA). Cases of CGNB were divided on the basis of the morphologic features of neuroblastic elements into three prognostic subgroups: “Type A Intermixed,” having individual microscopic nests of neuroblasts (N=4, 100% survival); “Type B Intermixed,” having microscopic aggregates of multiple neuroblastic nests (N=6, 67% survival); and “Nodular,” having grossly visible nodule(s) of neuroblastic proliferation (N=8, 0% survival). Survival rates are significantly different for the prognostic subgroups (P < 0.025). Each prognostic subgroup demonstrated an immunohistochemically distinct pattern of stromal cell composition in the neuroblastic elements: Type A Intermixed had numerous S‐100 cells and no FER cells, Type B Intermixed contained many S‐100 cells and a moderate number of FER cells, and Nodular had few S‐100 cells with many FER cells. The S‐100 and FER scores, determined by counting the positive cells through a line sampling method, differed significantly between these prognostic subgroups. Lymphocytic aggregations in tumor tissue evaluated by volumetric assessment with LCA staining, on the other hand, showed no contribution in predicting the outcome of the patients. There was also an inverse relationship between S‐100 and FER score, suggesting a relationship between the relative predominance of these stromal cell types, tumor histopathologic features, and the biologic behavior of CGNB.