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    Pathology of CNS Tumors

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    Naglaa Ramadan
    John, a 48-year-old male, presented with abdominal distension and jaundice. His liver biopsy showed two pathological features: (1) cirrhosis of the liver seen microscopically in Areas A and B, and (2) this condition can result from chronic hepatitis B or C infection common in the Pacific region. Alipate, a 61-year-old male, presented with urinary difficulties for 3 years. Examination of his bladder and prostate showed features of benign prostatic hyperplasia. Microscopic examination of his prostate biopsy showed abnormal cells in Area B, featuring proliferative glands. A prostate-specific antigen blood test would likely be elevated in this patient.

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    Pathology of CNS Tumors

    Uploaded by

    Naglaa Ramadan
    467 views58 pages
    John, a 48-year-old male, presented with abdominal distension and jaundice. His liver biopsy showed two pathological features: (1) cirrhosis of the liver seen microscopically in Areas A and B, and (2) this condition can result from chronic hepatitis B or C infection common in the Pacific region. Alipate, a 61-year-old male, presented with urinary difficulties for 3 years. Examination of his bladder and prostate showed features of benign prostatic hyperplasia. Microscopic examination of his prostate biopsy showed abnormal cells in Area B, featuring proliferative glands. A prostate-specific antigen blood test would likely be elevated in this patient.

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    John, a 48-year-old male, presented with abdominal distension and jaundice. His liver biopsy showed two pathological features: (1) cirrhosis of the liver seen microscopically in Areas A and B, and (2) this condition can result from chronic hepatitis B or C infection common in the Pacific region. Alipate, a 61-year-old male, presented with urinary difficulties for 3 years. Examination of his bladder and prostate showed features of benign prostatic hyperplasia. Microscopic examination of his prostate biopsy showed abnormal cells in Area B, featuring proliferative glands. A prostate-specific antigen blood test would likely be elevated in this patient.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    467 views58 pages

    Pathology of CNS Tumors

    Uploaded by

    Naglaa Ramadan
    John, a 48-year-old male, presented with abdominal distension and jaundice. His liver biopsy showed two pathological features: (1) cirrhosis of the liver seen microscopically in Areas A and B, and (2) this condition can result from chronic hepatitis B or C infection common in the Pacific region. Alipate, a 61-year-old male, presented with urinary difficulties for 3 years. Examination of his bladder and prostate showed features of benign prostatic hyperplasia. Microscopic examination of his prostate biopsy showed abnormal cells in Area B, featuring proliferative glands. A prostate-specific antigen blood test would likely be elevated in this patient.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    of 58

    Path S.

    OSPE 2004: (11 fail)


    John, a 48 year old male presented with abdominal
    distension and jaundice. The specimen displayed is a
    slice of his liver and the photograph shows the
    microscopic image of his liver biopsy.
    Look at the specimen jar.
    List two gross pathological features seen.
    [1]
    Look at the Photomicrograph liver biopsy.
    Identify two microscopic features labeled A & B ? [1]
    What clinical condition results from the process
    demonstrated in the photomicrograph ()? Explain the
    mechanism.
    [2]
    Mention two common etiological factors for this
    condition in the pacific?
    [1]

    Area-A

    Area-B

    Path OSPE 2: (13 fail)


    Alipate, a 61 year old male presented with pain
    and difficulty during micturition gradually
    increasing for the past 3 years.
    Look at Pic1 his bladder with prostate.
    What is the most probable clinical diagnosis?[]
    List 4 features of the disease seen in the
    picture? [2]
    Look at picture 2 Prostate gland biopsy with two
    areas marked A & B by a dotted line.
    Which area is abnormal? List one microscopic
    feature seen in this area?
    [1]
    Name the laboratory test done to diagnose
    malignancy in this condition? What result you
    would expect in this patient?
    [1]

    CNS Tumors

    In every person who comes


    near you look for what is good
    and strong; honor that; try to
    learn it, and your faults will
    drop off like dead leaves when
    their time comes.
    --John Ruskin

    Pathology of

    CNS Tumors
    Dr. Venkatesh M. Shashidhar, MD
    Associate Professor of Pathology
    Fiji School of Medicine
    SUVA, Fiji Islands.
    Fiji School of Medicine Commitment to Excellence

    CNS Tumors

    General Considerations
    Limited space, filled by Delicate vital structure..

    Normal brain is semifluid in consistency.!


    Highly sensitive to hypoxia, Critical blood supply
    Increased pressure destructive.
    Location determines nature than the tumor
    itself.

    Common site of metastasis.

    CNS Tumors

    General Considerations
    Comprise: 10% of all tumors

    Most common childhood neoplasms


    Peak incidence at 5th decade
    Supratentorial tumors in adults
    Infratentorial tumors in childhood
    Primary tumors infiltrative

    Metastasis well-demarcated
    Intraneural spread, no extraneural spread

    CNS Tumors

    Simple Classification:
    1. Primary Tumors:
    Mainly from supporting glia, nerve
    sheath, primitive cells, blood
    vessel/bone.

    2. Secondary Tumors - metastasis from


    Ca breast, lung, GIT etc.* Commonest.
    Mature Neurons do not give rise to neoplasms.
    (Permanent cells)

    CNS Tumors

    Primary brain tumors.


    Meninges: meningioma
    Glia Astrocytes - astrocytoma
    Oligodendrocytes - oligodendroglioma
    Ependyma ependymoma, choroid plexus
    papilloma, colloid cyst (Ventricles).

    Primitive cells: blastoma e.g. neuroblastoma.


    Neuronal * : ganglioglioma, gangliocytoma
    Nerve sheath: schwannoma, neuroblastoma
    Pituitary: adenoma, craniopharyngioma
    Vascular & Bone tumors:

    CNS Tumors

    Clinical features:
    Raised Intracranial Pressure.
    Headache, vomiting, slow pulse,
    papilloedema.

    Local damage:
    Nerve & tract deficits, Paralysis,
    seizures etc.

    CNS Tumors

    Meningioma:

    Arise from arachnoid granulations of


    venous sinuses. Attached to dura.
    Common sites: parasagittal (falx), sphenoid
    ridge, olfactory groove
    Females common (2:1)
    Well demarcated Compression - No Invasion
    Microscopic: whorls and psammoma bodies
    Hyperostosis over the tumor.
    Slow growth, well differentiated, no spread
    (Benign).

    Meningioma

    CNS Tumors

    Meningioma

    CNS Tumors

    Meningioma

    CNS Tumors

    Meningioma

    CNS Tumors

    Meningioma

    CNS Tumors

    Meningioma

    Psammoma bodies

    CNS Tumors

    Glioma:

    Gliomas are neoplasms of glial cells.


    Astrocytoma Commonest benign
    tumors with malignant behavior.
    Ependymoma Rare, 4th ventricle.
    Oligodendroglioma Benign, adults,
    rare.

    CNS Tumors

    Astrocytoma

    Astrocytoma Commonest tumors of


    adults. (80%)
    Well differentiated, slow growing.
    Benign - but malignant behavior.
    Infiltrative, poor demarcation
    Glioblastoma Multiforme Malignant form of Astrocytoma.

    CNS Tumors

    Astrocytomas
    Adults:
    Supratentorial (Cerebrum),
    Solid, Malignant, Fibrillary

    Children:
    Infratentorial (Cerebellum),
    Cystic, Benign, Pilocytic

    CNS Tumors

    Fibrillary astrocytomas
    Grossly solid
    Common in cerebral hemispheres
    Low grade in young, higher grade in
    older
    Grading
    astrocytoma (low grade)
    Anaplastic astocytoma
    glioblastoma multiforme (high grade)

    Astrocytoma - fibrillary

    CNS Tumors

    Fibrillary astrocytoma:
    microscopic

    Low grade- hypercellularity, pleomorphism


    Anaplastic- as above plus mitosis, vascular
    endothelial proliferation
    Glioblastoma multiforme- as above plus
    necrosis and pseudopalisades. Grossly
    variegated appearance (multiforme)

    Glioblastoma high grade Astrocytoma

    Glioma Brain Stem

    CNS Tumors

    Glioma Cerebrum

    Glioma:

    Fibrillary Astrocytoma (Glioma)

    Glioblastoma Multiforme

    Glioblastoma Cerebrum

    Glioma:

    Glioma

    Astrocytoma

    Glioblastoma Multiforme

    Glioblastoma Multiforme

    CNS Tumors

    Pilocytic astrocytoma

    Common in childhood
    Most slow growing of the gliomas
    Sites: cerebellum, around III V., optic nerve
    Grossly cystic with mural nodule
    Microscopic
    elongated hair-like (pilo) elongated cells
    Rosenthal fibers

    Pilocytic Astrocytoma - children

    Pilocytic astrocytoma
    Mural nodule

    Formerly, when religion was


    strong and science weak, men
    mistook magic for medicine.

    Now, when science is strong and


    religion weak, men mistake
    medicine for magic.

    Other CNS tumors

    CNS Tumors

    Neuroectodermal Tumors

    1.
    2.
    3.
    4.

    Origin from primitive blast cells.


    Rosettes - attempted nerve formation.
    Medulloblastoma Cerebellum
    Retinoblastoma - Retina
    Neuroblastoma Adrenal glands
    Ganglioneuroma - Mediastinum

    Medulloblastoma

    Medulloblastoma

    CNS Tumors

    Nerve Sheath Tumors:

    Neurofibroma:

    Epi & endoneurial fibroblasts.


    Form whorls of fibroblasts with nerves
    Well differentiated, benign, capsulated.

    Schwannoma:

    Schwann cells, form whorls


    Nuclear palisading

    Schwannoma Cerebellum

    Ependymoma Cerebellum

    Ependymoma-hemorrhage

    Ependymoma

    CNS Tumors

    Neurilemmoma

    Schwannoma

    Schwannoma

    Schwannoma

    It has been my
    philosophy of life that
    difficulties vanish
    when faced boldly.
    --Isaac Asimov

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