Development of the WHO classification of tumors of the central nervous system: a historical perspective

Abstract

The classification of brain tumors has undergone numerous changes over the past half century. The World Health Organization has played a key role in the effort. Four versions of its Classification of Tumours of the Central Nervous System have been published. The present work chronicles their progress, placing emphasis on the historical context of the earliest effort.

Figure 1

Dr Karl Joachim Zülch (1910–1988), organizer of the first World Health Organization Working Group meeting and author of the first “blue book,” Histologic Typing of Tumours of the Central Nervous System.

Figure 2

(A) Drs Lucien J. Rubinstein (1924–1990), (B) Robin O. Barnard (1932–2005) and (C) Kenneth Earle (1919–1996) were among the participants who formulated the first World Health Organization classification of central nervous system tumors.

Figure 3

(A) Drs John J. Kepes, (B) David Robertson and (C) J. Hume Adams were among the 10 100‐case reviewers who correlated their diagnoses with the proposed World Health Organization classification.

Figure 4

The first World Health Organization Working Group including invited guests in Cologne, Germany, 1976. In the front row (left to right) are Drs K. J. Zülch (Federal Republic of Germany), K. M. Earle (USA), L. H. Sobin (USA) and A. P. Avtsyn (USSR). In the back row (left to right) are Drs B. Horton (guest; USA), R. Fankhauser (Switzerland), H.‐D. Mennel (guest; Federal Republic of Germany), E. Wildi (guest; Switzerland), J.‐M. Brucher (Belgium), L. J. Rubinstein (USA), Y. Ishida (Japan), A. Kunicki (Poland), J. E. Olvera Raviela (Mexico), T. Rabinowicz (Switzerland), R. O. Barnard (England) and J. Szymas (guest; Poland).

Figure 5

The co‐chair, Dr Kenneth M. Earle (left), chairman, Dr Klaus J. Zülch (center) and secretariat Dr Leslie H. Sobin (right) at the first 1974 World Health Organization Working Group Meeting in Cologne, Germany.

Figure 6

Three lesions at the center of controversy at the meetings of the first World Health Organization Working Group included the (A) giant cell glioblastoma (“monstrocellular” sarcoma), (B) desmoplastic medulloblastoma (“circumscribed cerebellar sarcoma”) and (C) germinoma (“pinealoma”). Illustrations are from originally circulated cases examined by the reviewers (courtesy of Dr David Robertson, Kingston, Ontario, Canada and Dr Glen Sanberg, Armed Forces Institute of Pathology, Washington, DC).

Figure 7

The first edition (1979) of the World Health Organization Classification of Tumours of the Central Nervous System. The distinctive color of this series (A) lent the designation “blue books” to the entire series, a term still loosely applied to subsequent editions. (B) Title page.

Figure 8

Dr Paul Kleihues, organizer and coeditor of the second and third editions of the World Health Organization blue book.

Figure 9

The 2007 WHO Classification of Tumours of the Central Nervous System. A highly illustrated, state‐of‐the‐art text replete with in‐depth treatment of molecular and genetic aspects of the lesions.

Figure 10

The World Health Organization grades of central nervous system tumors according to the 2007 Classification of Tumours of the Central Nervous System.