Pathology of CNS Tumors

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 (½)? 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?[½] 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 A B . honor that.In every person who comes near you look for what is good and strong. try to learn it. --John Ruskin . and your faults will drop off like dead leaves when their time comes. MD Associate Professor of Pathology Fiji School of Medicine SUVA. Venkatesh M.Pathology of CNS Tumors Dr. Fiji School of Medicine – Commitment to Excellence… . Shashidhar. Fiji Islands. . filled by Delicate vital structure. Critical blood supply  Increased pressure – destructive.  Location determines nature than the tumor itself. .  Normal brain is semifluid in consistency….!  Highly sensitive to hypoxia.CNS Tumors General Considerations  Limited space.  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 . blood vessel/bone. nerve sheath.metastasis from Ca breast.* Commonest. “Mature Neurons do not give rise to neoplasms. primitive cells. lung. 2. Primary Tumors:  Mainly from supporting glia. GIT etc. Secondary Tumors .CNS Tumors Simple Classification: 1.” (Permanent cells) . astrocytoma  Oligodendrocytes .CNS Tumors Primary brain tumors.oligodendroglioma  Ependyma – ependymoma. neuroblastoma. Neuronal * : ganglioglioma. colloid cyst (Ventricles).g. gangliocytoma Nerve sheath: schwannoma.  Meninges: meningioma  Glia  Astrocytes . choroid plexus papilloma.      Primitive cells: “blastoma” e. craniopharyngioma Vascular & Bone tumors: . neuroblastoma Pituitary: adenoma. . vomiting. slow pulse. Paralysis.CNS Tumors Clinical features:  Raised Intracranial Pressure.  Local damage:  Nerve & tract deficits.  Headache. seizures etc. papilloedema. sphenoid ridge. no spread (Benign). Attached to dura. olfactory groove Females common (2:1) Well demarcated – Compression . well differentiated.CNS Tumors Meningioma:        Arise from arachnoid granulations of venous sinuses. Common sites: parasagittal (falx). .No Invasion Microscopic: whorls and psammoma bodies Hyperostosis over the tumor. Slow growth. . Meningioma . CNS Tumors Meningioma . CNS Tumors Meningioma . CNS Tumors Meningioma . CNS Tumors Meningioma . CNS Tumors Meningioma . Psammoma bodies . Oligodendroglioma – Benign.CNS Tumors Glioma:     Gliomas are neoplasms of glial cells. 4th ventricle. adults. rare. Ependymoma – Rare. Astrocytoma – Commonest benign tumors with malignant behavior. . slow growing. Benign . . Infiltrative.but malignant behavior. (80%) Well differentiated. poor demarcation Glioblastoma Multiforme Malignant form of Astrocytoma.CNS Tumors Astrocytoma      Astrocytoma – Commonest tumors of adults. CNS Tumors Astrocytomas Adults:  Supratentorial (Cerebrum). Pilocytic .  Solid. Benign. Malignant. Fibrillary Children:  Infratentorial (Cerebellum).  Cystic. 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) . fibrillary .Astrocytoma . hypercellularity. Grossly variegated appearance (multiforme) . vascular endothelial proliferation  Glioblastoma multiforme.as above plus mitosis.CNS Tumors Fibrillary astrocytoma: microscopic  Low grade. pleomorphism  Anaplastic.as above plus necrosis and pseudopalisades. 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 . Now. men mistook magic for medicine. when religion was strong and science weak. men mistake medicine for magic.Formerly. when science is strong and religion weak. . Other CNS tumors . 2. Rosettes .attempted nerve formation. Origin from primitive blast cells.Retina Neuroblastoma – Adrenal glands Ganglioneuroma .Mediastinum . Medulloblastoma – Cerebellum Retinoblastoma . 4. 3.CNS Tumors Neuroectodermal Tumors   1. Medulloblastoma . Medulloblastoma . CNS Tumors Nerve Sheath Tumors:  Neurofibroma:     Epi & endoneurial fibroblasts. capsulated. benign. Schwannoma:   Schwann cells. form whorls Nuclear palisading . Form whorls of fibroblasts with nerves Well differentiated. 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 .