AMAarchives of neurology & psychiatry . of more rapid growth. The early tumor is merely a collection of large cells with neuroglia fibersrunning between cells and surrounding it. In the larger tumors the cells are FREEM AX—TUBEROUS SCLEROSIS 627 more numerous and the glia filters are proportionately diminished. Theyseparate it into cell groups by trabeculae, and wall it off from the underlyingganglion. Many vessels in these moderate sized tumors are infiltrated withcalcium salts (Fig. 9). There is granular ependymitis in the vicinity of thetumors (Fig. 3). Whether the cells of these subependym
AMAarchives of neurology & psychiatry . of more rapid growth. The early tumor is merely a collection of large cells with neuroglia fibersrunning between cells and surrounding it. In the larger tumors the cells are FREEM AX—TUBEROUS SCLEROSIS 627 more numerous and the glia filters are proportionately diminished. Theyseparate it into cell groups by trabeculae, and wall it off from the underlyingganglion. Many vessels in these moderate sized tumors are infiltrated withcalcium salts (Fig. 9). There is granular ependymitis in the vicinity of thetumors (Fig. 3). Whether the cells of these subependymal tumors are ofnervous or supporting origin is contested, some authors considering them aslarge cell gliomas, others as ganglioneuromas, and still others as neuro-blastomas. The majority ally them with the gliomas. The typical cells of these tumors are fusiform or retort-shaped, vary insize up to that of the largest of the Betz cells, have no tigroid bodies orneurofibrillae, and send processes away from one or both ends. Some of the. Fig. 10.—Low-power view of multilocular cyst. cells are almost round and have no processes. The nuclei are usually large,with definite nuclear memljrane. delicate chromatin network, and only occa-sional nucleoli. Sometimes the nuclei are grotesque in size or shape, or twoor more nuclei are found in the same cell. Mitotic figures are absent. Manyof the larger cells have vacuoles but otherwise do not seem to be degenerated. The fibers sent off by the large cells run in bundles and separate the cellsfrom one another into groups. Among these fibers lie cells of a differentcharacter, usually much elongated, with large distorted nuclei and processesfollowing the cell outline. These take the glia stain typically whereas thelarge cells stain like ganglion cells. The large tumor in this case varied in microscopic as well as gross char-acteristics from the others. The cells were not divided into groups, and glia 628 ARCIIIlES OF NEUROLOGY AND PSYCHIATRY
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