Neuropathology tumours
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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
Gross
- Do NOT smear.
Micro.
- Rosenthal fibres - key feature.
- Image: [1]
![[1]](http://en.wikipedia.org/wiki/File:Rosenthal_HE_40x.jpg){kind=link}
DDx (of Rosenthal fibers):[4]
- Chronic reactive gliosis.
- Subependymoma.
- Ganglioma.
- Alexander's disease (rare leukodystrophy).
Oligodendroglial tumours
Arise from oligodendrocytes.
Micro
- Calcifications.[5] - key feature.
- Oligodendrocytes.
- Cells with clear cytoplasm.
- Abundant delicate vessels (may vagues resemble paraganglioma at low power).
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.
Choriod plexus papilloma
Microscopy
Features:
- Papillae.
- Psammoma bodies.
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
- ↑ 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.
External links
- Neuropathology - neuropathologyweb.org.
- Neuropathology Mini-Course - pathology.vcu.edu.