Diagnostic Images: Homer Wright Rosettes

Femela. M

Consultant – Pathology, Kauvery Hospital, Radial Road, Chennai, Tamil Nadu

Diagnostic Images

Fig (a)

Fig (b)

Fig (c)

Fig (a, b, c): Homer Wright Rosettes

Definition

  • Homer Wright rosettes are a histological structure seen in certain types of neuroectodermal tumors, particularly neuroblastomas.
  • They consist of tumor cells arranged in a circular pattern around a central area of fibrillary processes, but without a true lumen (unlike Flexner–Wintersteiner rosettes).

Histological Features

  • Central Core: Composed of eosinophilic neurofibrillary material (neuropil), representing tangles of neuritic processes.
  • Peripheral Cells: Small, round, hyperchromatic cells arranged in a radial pattern.
  • No true lumen is present (key distinguishing feature).
  • Best appreciated with H&E staining, though immunohistochemistry (e.g., synaptophysin, NSE) may be used to support diagnosis.

Tumors Associated with Homer Wright Rosettes

  1. Neuroblastoma
  2. Medulloblastoma
  3. Pineoblastoma/Pineocytoma
  4. Primitive neuroectodermal tumors (PNETs)

Diagnostic Value

  • Presence of Homer Wright rosettes supports the diagnosis of neuroblastic tumors but is not pathognomonic.
  • Differentiates from other rosette types
    • Flexner–Wintersteiner rosettes: Have a true central lumen, typically seen in retinoblastoma.
    • Perivascular pseudorosettes: Tumor cells arranged around blood vessels, often seen in ependymomas.

Historical Background

  • Named after James Homer Wright, an American pathologist, who first described them in 1910 in relation to neuroblastoma.

Clinical Relevance

  • Identification aids in tumor classification, prognostication, and therapeutic decisions.
  • Indicates a degree of neuronal differentiation.

References

  • Rosai, J. (2011). Rosai and Ackerman’s Surgical Pathology. 10th ed. Elsevier.
  • Louis, D. N., Ohgaki, H., Wiestler, O. D., & Cavenee, W. K. (2016). WHO Classification of Tumours of the Central Nervous System, Revised 4th ed. IARC.
  • Kumar, V., Abbas, A. K., & Aster, J. C. (2020). Robbins and Cotran Pathologic Basis of Disease. 10th ed. Elsevier.
  • Wright, J. H. (1910). The histogenesis of neuroblastoma. Journal of Experimental Medicine, 12(3), 556–561. https://doi.org/10.1084/jem.12.3.556
  • Perry, A., & Brat, D. J. (2017). Practical Surgical Neuropathology: A Diagnostic Approach. 2nd ed. Elsevier.

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