NEUROPATHOLOGY

1. NEUROPATHOLOGY

14. Microscopic image Q9. List three key histopathologic features as noted at the arrows. Large pleomorphic cells, angiogenesis, necrosis Q10. What is the diagnosis? Glioblastoma

15. Q7. Is this benign or malignant? Why? This is an image of a gross specimen from an identical tumor arising from a peripheral nerve. The tumor cells are intermingled with the axons. http://radiology.uchc.edu/eAtlas/CNS/709.htm The patient is referred to neurosurgery. He undergoes surgery via a posterior spinal approach. The neurosurgeon finds a large intradural, extramedullary mass arising from the left C7 nerve root and filling the spinal canal, deforming and compressing the spinal cord.

16. Microscopic image Q8. Describe the histopathology image. Shape and size of cells. Appearance of the nuclei. Is this benign or malignant? spindle cells with uniform nuclei, benign Q9. What is the diagnosis? Neurofibroma

17. Neoplasia Nervous System • Meningioma • Glial Tumors: Astrocytoma-Glioblastoma; Oligodendroglioma; • Metastatic Lesions

18. Normal Histology Central Nervous System CORTEX NEURON ASTROCYTE MENINGES OLIGODENDROCYTE

19. Meningioma

20. Meningioma • Benign, Adults; Women: Men 3:2 • Multiple lesions associated with NF2 • Arachnoid meningothelial cell • External surfaces: parasagittal convexity • Encapsulated, well defined dural base • Slow growing • Progesterone Receptors

21. Meningioma DURA

22. Microscopic • Uniform plump to spindle cells in bundles • Classic “whorling” pattern • Syncytial, transitional, fibroblastic, psammomamatous types • Mitoses, pleomorphism suggest Atypical/Aggressive type

23. Meningioma Normal meninges Psammomatous meniongioma PSAMMOMA BODY

24. Meningioma WHORLS Syncytial appearance

25. Glial TumorsAstrocytoma-Glioblastoma Spectrum • 80% of adult primary brain tumors • Cerebral hemispheres but also brain stem • Deceptively well demarcated grossly • Spreads within brain but no metastasis to other organs • Aggressiveness correlated with tumor grade • WHO grades I-IV

26. Astrocytoma Grade I-II • Well differentiated fibrillary astrocytoma • Mild to moderate increase in nuclei • Variable nuclear pleomorphism • GFAP positive astrocytic cell processes • Indistinct transition from normal tissue • Tumor cells infiltrate millimeters from main tumor mass

27. Astrocytoma Grade I-II * * * Mass lesion with infiltration, ill-defined, expanding white matter No hemorrhage or necrosis

28. Astrocytoma Grade I-II

29. Astrocytoma Grade IIIAnaplastic Astrocytoma • Increased dense cellularity • Increased nuclear pleomorphism • Mitoses

30. Astrocytoma Grade IIIAnaplastic Astrocytoma Hypercellularity Pleomorphism Mitosis

31. Glioblastoma(Grade IV Astrocytoma)Old name Glioblastoma Multiforme • High cellularity, pleomorphism, mitoses • Necrosis “pseudopalisade) • Vascular Proliferation (Angiogenesis) • Rapid growth, mass lesion effects • Aggressive Lesions < 10% survival in 2 years

32. Hemorrhagic mass lesion Necrosis Crosses midline Glioblastoma

33. Glioblastoma PSEUDOPALISADE

34. Glioblastoma

35. Glioblastoma VASCULAR PROLIFERATION NECROSIS

36. Glioblastoma GFAP Ki67

37. Glial TumorsOligodendroglioma • 5-15% glial tumors • Cerebral hemispheres, white matter • Well circumscribed, gelatinous, cystic • Sheets of uniform cells with central nuclei and a clear halo of cytoplasm (“fried eggs”) • Calcification, slow growth • Prognostic value loss of 1p and 19q

38. Oligodendroglioma Non-tumor Tumor Hydrocephalus Diffusely infiltrating oligodendroglioma, expanding corpus callosum and white matter (arrows), and invading the basal ganglion (arrowhead)

39. Oligodendroglioma “Fried egg” appearance or perinuclear halo

40. Metastatic Lesions • 25% of intracranial malignant tumors are metastases • Carcinomas most common: lung, breast, kidney • Melanoma • Meningeal carcinomatosis, multiple small nodules of tumor

41. MetastaticSmall Cell Carcinoma

42. Brain MetastasesSmall Cell Carcinoma, Lung Primary

43. Metastatic Carcinoma, Lung Primary

44. Metastatic Adenocarcinoma