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Pathology of CNS Tumors

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Primary children - 50% infiltrative. Metastatic adults - well-demarcated. ... Oligodendroglioma Mosaic/poached-egg. Ependymoma Perivascular pseudorosettes ... – PowerPoint PPT presentation

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Title: Pathology of CNS Tumors


1
Pathology of CNS Tumors
  • Dr. Venkatesh M. Shashidhar, Associate Professor
    of Pathology
  • Fiji School of Medicine

2
General Considerations
  • Common childhood tumor.
  • Comprise 10 of all tumors
  • Peak incidence at 5th decade
  • Supratentorial tumors in adults
  • Infratentorial tumors in childhood

3
General Considerations
  • Primary children - 50 infiltrative
  • Metastatic adults - well-demarcated.
  • Limited space, Vital structures
  • Location determines prognosis.
  • Rare extra neural metastasis.

4
Classification
  • Primary neural tumors - Rare (Neuroblastoma,
    ganglioneuroma)
  • Common - Tumors of supporting structures.
  • Glia, Meninges, Blood vessels, fibrous tissue.
  • Secondary Metastasis (50)

5
Types of Brain Tumors
  • Meninges meningioma, hemangiopericytoma
  • Glia astrocytoma, oligodendroglioma, ependymoma,
    choroid plexus papilloma..
  • Vascular hemangioblastoma.
  • Primitive cells neuroblastoma, germinoma,
    medulloblastoma, pineoblastoma, retinoblastoma
  • Neuronal ganglioglioma, gangliocytoma
  • Pituitary adenoma, craniopharyngioma
  • Nerves schwannoma, neurofibroma, MPNST

6
Meningioma
  • Arise from meningothelial cells of arachnoid
    granulations.
  • Adjacent to venous sinuses.
  • Nodular, capsulated, slow growing-Benign.
  • Form whorls of cells, Psammoma bodies in the
    center.
  • Effect by pressure.
  • No infiltration or metastasis (Benign).

7
Meningioma
8
Meningioma
9
Meningioma
10
Meningioma
11
Menoingioma
12
Psammoma bodies in meningioma
13
Glioma
  • Gliomas are neoplasms of glial cells.
  • Astrocytoma Commonest benign tumor with
    malignant behavior.
  • Ependymoma Rare, 4th ventricle.
  • Oligodendroglioma Benign, adults, rare.

14
Astrocytoma
  • Fibrillary or diffuse astrocytoma - 80
  • Anaplastic/high grade astrocytoma
  • Glioblastoma multiforme
  • Gemistocytic astrocytoma
  • Pilocytic astrocytoma(Juvenile)
  • Pleomorphic astrocytoma
  • Xanthastrocytoma
  • Gliomatosis cerebri. Others..

15
Astrocytoma
  • Cerebrum, 4th to 6th decade.
  • Headache, seizures neurological deficits.
  • 3 tier or 4 tier grading system.
  • Anaplasia,
  • Mitotic activity,
  • Necrosis
  • Endothelial proliferation.
  • Well differentiated, anaplastic Glioblastoma
    multiforme.

16
Astrocytomas
Adults Childhood
SupratentorialSolidMalignantFibrillary Infrat
entorialCysticBenignPilocytic
17
Fibrillary astrocytoma microscopic
  • Low grade- hypercellularity, pleomorphism
  • Anaplastic- high grade plus will have more
    mitosis vascular endothelial proliferation
  • Glioblastoma multiforme- plus necrosis and
    pseudopalisades. Grossly variegated appearance
    (multiforme)

18
(No Transcript)
19
Glioma Brain Stem
20
Glioma Cerebrum
21
GBM
22
Glioma Cerebrum
23
Glioblastoma Multiforme
24
Glioblastoma Multiforme
25
Glioblastoma Multiforme
26
Glioma
27
Glioma
28
Glioblastoma Multiforme
29
"The gem cannot be polished without friction, nor
man perfected without trials or problems or
exams!." --Chinese proverb
30
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

31
Rosenthal fiber definition
  • Dense, eosinophilic fibers within cytoplasmic
    processes of astrocytes.
  • Correspond to aggregate accumulation of
    intermediate filaments in these processes.

32
Pilocytic Astrocytoma
"juvenile astrocytomas, cystic Most common in
children. below the tentorium, posterior fossa.
33
Pilocytic astrocytoma Mural nodule
34
Oligodendroglioma
  • Cells of origin Oligodendrocytes
  • Common in cerebral hemispheres
  • Calcifications common among all gliomas
  • Grades Low grade Anaplastic

35
Oligodendroglioma
36
Ependymoma-hemorrhage
37
Ependymoma Cerebellum
38
Spinal Ependymoma
39
Ependymoma
40
Neuroectodermal Tumors
  • Origin from primitive blast cells.
  • Rosettes - attempted nerve formation.
  • Medulloblastoma Cerebellum
  • Retinoblastoma - Retina
  • Neuroblastoma Adrenal glands
  • Ganglioneuroma - Mediastinum

41
Medulloblastoma
  • Origin primitive neuroectodermal cells
  • Age 1st decade of life. Most common brain tumor
    at this age.
  • Site vermis of cerebellum
  • May cause hydrocephalus
  • Subarachnoid dissemination

42
Medulloblastoma
43
Medulloblastoma
44
Colloid cyst III Ventricle
45
Medulloblastoma
46
The ability to listen, understand and empathise
creates a feeling of trust and friendship in
others. If we are always willing to listen, we
can help them discover their own solutions to the
problems they have to face. BK.
47
Peripheral Nerve(Sheath) Tumors
  • Neurofibroma
  • Schwannoma

48
Nerve Sheath Tumors
  • Neurofibroma
  • Epi endoneurial fibroblasts.
  • Form whorls of fibroblasts
  • Well differentiated, benign,
  • Two types
  • Classic form - Cutaneous / nerve - Solitary
    collagen matrix, spindle cells,
  • Plexiform - Multiple, infiltrative, myxoid.

49
Nerve Sheath Tumors
  • Schwannoma
  • Schwann cells, form whorls
  • Nuclear palisading
  • Antoni A B pattern.
  • Verocay bodies.

50
Schwannoma
51
Neurilemmoma
52
Schwannoma/Acoustic neuroma
53
Schwannoma Cerebellum
54
Neurofibromatosis
  • Type I (common)(AD, 17q, 13000)
  • Plexiform solitary neurofibromas
  • Optic nerve gliomas, Lisch nodules, Café au lait
    spots.
  • Type II (rare)(22q, 140,000)
  • Bilateral acoustic schwannoma/osis
  • Multiple meningioma/osis, ependymoma of spinal
    cord

55
Phakomatosis (Neurocut. dysplasia)
  • Neurologic abnormalities defects of skin or
    retina (ectodermal).
  • Neurofibromatosis (von Recklinghausen)
  • Tuberous Sclerosis
  • Sturge-Weber Sy (Encephalofacial Angiomatosis)
  • von Hippel-Lindau Disease
  • Neurocutaneous Melanosis

56
Neurofibromatosis - Von Recklinghausen
  • Dominant inheritance
  • Multiple neurofibromas
  • Central - CNS
  • peripheral nerves
  • Increased incidence of
  • meningioma
  • glioma
  • schwannoma - bilateral VIII N.
  • Cafe-au-lait (melanosis) in skin
  • Elephantiasis increased connective tissue

57
Von Recklinghausens Disease
Café-au-lait spots
Multiple neurofibromas
58
Tuberous Sclerosis
1. Dominant inheritance 2. Clinical
triad seizures mental retardation adenoma
sebaceum 3. Retinal hamartoma (phakoma) 4.
Tubers in cerebral cortex 5. Subependymal giant
cell astrocytoma 6. Hamartomas in other organs
heart, kidney
59
Tubers
60
Adenoma sebaceum
61
Von Recklinghausen Disease
62
Neurofibromatosis Type II
  • Bil Schwannomas
  • Meningiomas
  • Gliomas
  • Pheochromocytomas

63
Von Recklinghausen Disease
64
Plexiform Neurofibroma
65
Medulloblastoma
"small round blue cell" tumors and it most often
occurs in children.
66
Brain Metastasis - (lung)
67
Metastatic tumors
68
Brain Metastasis
69
Peripheral nerve tumors
  • Neurofibroma
  • Schwann cells, neurites, fibroblasts
  • Fusiform and involves nerve trunk
  • Not encapsulated
  • Not resectable without sacrificing nerve
  • Micro- Intermingled cells with wavy nuclei
  • Schwannoma
  • Schwann cells
  • Compress the nerve trunk
  • Encapsulated
  • Easily resectable without nerve damage
  • Microscopic
  • Antony A and B fibers
  • Verocay bodies

70
AcousticSchwannoma
71
Brain Tumors Microscopic
Tumor
Microscopic Meningioma Whorls and
psammoma bodies Glioblastoma
Pseudopalisades Oligodendroglioma
Mosaic/poached-egg Ependymoma
Perivascular pseudorosettes Medulloblastoma
Rosettes (Homer-Wright)
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