Difference between revisions of "Neuropathology tumours"
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===Microscopic=== | ===Microscopic=== | ||
*Calcifications.<ref>[http://www.emedicine.com/radio/topic481.htm http://www.emedicine.com/radio/topic481.htm]</ref> - | Features: | ||
*Highly cellular lesion composed of: | |||
**Cells resembling ''fried eggs'' (oligodendrocytes) with: | |||
***Distinct cell borders. | |||
***Moderate-to-marked nuclear atypia. | |||
***Clear cytoplasm. | |||
**Acutely branched capillary sized vessels - "chicken-wire" like appearance. | |||
***Abundant, delicate appearing; may vaguely resemble a paraganglioma at low power. | |||
*Calcifications.<ref>URL: [http://www.emedicine.com/radio/topic481.htm http://www.emedicine.com/radio/topic481.htm].</ref> - important feature. | |||
Images: | Images: | ||
Revision as of 19:09, 18 May 2010
The article covers CNS tumours, including Brain tumours. They are relatively common and mostly real badness. Tumours are a large part of neuropathology.
The article also includes peripheral nerve sheath tumours.
Brain tumours
Adult
Four most common types of brain tumours:[1]
- Metastatic brain tumours (barely edges out primary tumours)
- Lung (most common),
- Breast,
- Melanoma,
- Renal cell carcinoma (RCC).
- Glioblastoma aka glioblastoma multiforme.
- Anaplastic (malignant) astrocytoma.
- Meningioma.
Children
- Astrocytoma.
- Medulloblastoma.
- Ependymoma.
Astrocytomas
- Pilocytic astrocytomas (WHO Grade I).
- Dysembryoplastic neuroepithelial tumour (DNT), (WHO Grade I).
- Low-grade (diffuse) astrocytomas (Grade II).
- Anaplastic astrocytomas (Grade III).
- Glioblastoma (Grade IV).
- Nuclear pleomorphism.
- Mitotic figures.
- Microvascular proliferation or necrosis with pseudopalisading tumour cells.
- Pseudopalisading tumour cells = high tumour cell density adjacent to regions of necrosis; palisade = a fence of pales forming a defense barrier or fortification.
Pilocytic astrocytoma
- Low-grade astrocytoma.
Gross
- Do NOT smear.
Microscopic
- Rosenthal fibres - key feature.
- Image: Rosenthal fibres (WC).
DDx (of Rosenthal fibers):[4]
- Chronic reactive gliosis.
- Subependymoma.
- Ganglioma.
- Alexander's disease (rare leukodystrophy).
Oligodendroglioma
- Arise from oligodendrocytes.
Microscopic
Features:
- Highly cellular lesion composed of:
- Cells resembling fried eggs (oligodendrocytes) with:
- Distinct cell borders.
- Moderate-to-marked nuclear atypia.
- Clear cytoplasm.
- Acutely branched capillary sized vessels - "chicken-wire" like appearance.
- Abundant, delicate appearing; may vaguely resemble a paraganglioma at low power.
- Cells resembling fried eggs (oligodendrocytes) with:
- Calcifications.[5] - important feature.
Images:
Peripheral nerve sheath tumours
A classification:[6]
- Benign:
- Schwannoma.
- Neurofibroma.
- Perineurioma.
- Traumatic neuroma.
- Malignant:
- Malignant peripheral nerve sheath tumour (MPNST).
Schwannoma
- Tumour of tissue surrounding a nerve.
- Axons adjacent to the tumour are normal... but may be compressed.
Histology
Antoni tissue:[6]
Antoni A
- Cellular.
- 'Fibrillary, polar, elongated'.
Comment: May look somewhat like scattered matchsticks.
Antoni B
- Loose microcystic tissue.
- Adjacent to Antoni A.
Micrographs:
Neurofibroma
General:[6]
- Composed of Schwann cells, axons, fibrous material.
Appearance/morphology:[6]
- Plexiform growth pattern - "bag of worms".
Ependymoma
Microscopy
Features:
- Cells have a "tadpole-like" morphology.
- May also be described as ice cream cone-shaped.[7]
- Rosettes - cells arranged in a pseudoglandular fashion.
- "Nucleus free zones" - cells arranged around a blood vessel (pseudorosettes) - vessel not seen, only cytoplasm of tumour cells.
- The nucleus free zone is composed of tumour cell cytoplasm that is adjacent to an unseen blood vessel.
- Nuclear feature monotonous, i.e. "boring".[8]
DDx:
- Subependymoma.
Choroid plexus papilloma
Microscopy
Features:
- Papillae.
- Psammoma bodies.
Image:
Chordoma
- Location: usually sacrum or clivus.
Microscopic
Features:[9]
- Architecture: islands of cells surrounded by fibrous tissue.
- Also described as "lobulated" architecture; may not be apparent.
- Myxoid background - grey extracellular material, variable amount present.
- Mixed cell population:
- Abundant eosinophilic cytoplasm.
- Physaliphorous cells or bubble cells - key feature.
- Have a very large clear bubble with a sharp border; bubble does not compress nucleus - nucleus may be in bubble.
Image(s):
IHC
Features:
- S100 +ve.
- CK +ve.
- Brachyury +ve.
References
- ↑ http://neurosurgery.mgh.harvard.edu/abta/primer.htm
- ↑ Rong Y, Durden DL, Van Meir EG, Brat DJ (June 2006). "'Pseudopalisading' necrosis in glioblastoma: a familiar morphologic feature that links vascular pathology, hypoxia, and angiogenesis". J. Neuropathol. Exp. Neurol. 65 (6): 529–39. PMID 16783163.
- ↑ http://dictionary.reference.com/browse/palisading
- ↑ MUN. 9 Mar 2009.
- ↑ URL: http://www.emedicine.com/radio/topic481.htm.
- ↑ 6.0 6.1 6.2 6.3 Wippold FJ, Lubner M, Perrin RJ, Lämmle M, Perry A (October 2007). "Neuropathology for the neuroradiologist: Antoni A and Antoni B tissue patterns". AJNR Am J Neuroradiol 28 (9): 1633–8. doi:10.3174/ajnr.A0682. PMID 17893219. http://www.ajnr.org/cgi/reprint/28/9/1633.
- ↑ http://www.pathology.vcu.edu/WirSelfInst/tumor-2.html
- ↑ MUN. 6 Oct 2009.
- ↑ DCHH P.184.
- ↑ URL:http://www.ncbi.nlm.nih.gov/omim/601397. Accessed on: 18 May 2010.
- ↑ URL: http://www.jstor.org/pss/86845. Accessed on: 18 May 2010.
External links
- Neuropathology - neuropathologyweb.org.
- Neuropathology Mini-Course - pathology.vcu.edu.