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DODY NOVRIAL
LABORATORIUM OF PATHOLOGY
MF-JSU
Epidemiology
Microscopic pathology
– Geographic necrosis
– Perinecrotic pseudopalisading by tumor cells
– Usually areas of prominent cellularity and nuclear
pleomorphism
– Readily identifiable mitotic figures
– Vascular “endothelial” proliferation
Variants : giant cell glioblastoma, small cell glioblastoma, gliosarcoma
(temporal)
Genetically best characterized brain tumor
Astrocytoma Grade IV (GBM)
Oligodendroglioma (Low Grade)
Microscopic pathology
Sheets of cells, scant cytoplasm, rounded central nucleus, vesicular
chromatin
Vacuolated “fried egg” appearance—formalin fixation artifact
Minimal nuclear pleomorphism
Arcuate or “chicken wire” vascular pattern
Calcification—prominent at periphery, seen in 80–90% of cases
Cortical invasion
May see meningeal invasion with desmoplasia
Subpial and perineuronal arrangement of tumor cells
May see microcystic change
Rare mitoses at most
Oligodendroglioma (Low Grade)
Oligodendroglioma (High Grade)
Pleomorphic nuclei
Mitoses, often >5 mitotic figures per high-power fields
Vascular proliferation
Necrosis
Increased cellularity
Worse prognosis than low-grade tumor, median survival
3–4 years
1p and 19q chromosome deletions associated with
increased likelihood of chemoresponsiveness
Oligodendroglioma (High Grade)
Ependymoma (Low Grade)
Microscopic pathology
Extreme fibrillarity
Nuclei round to oval, “carrot-shaped”
Dense nuclear chromatin
Slight nuclear pleomorphism
Infrequent mitoses
Perivascular pseudorosettes
True ependymal rosettes
Blepharoplasts—intracytoplasmic, basal bodies of cilia, best seen
ultrastructurally
Variants: cellular, papillary, clear cell, tanycytic, melanotic,
lipomatous, giant cell, signet ring cell; no difference in prognosis
associated with these variants
May see focal calcification/ossification/ cartilage
Ependymoma (Low Grade)
Ependymoma (High Grade)
Rare
Precise histological criteria to distinguish from
ordinary ependymoma are not well defined
Increased mitoses
Nuclear and cellular pleomorphism
Hypercellularity
Vascular proliferation
Focal necrosis frequent
Ependymoma (High Grade)
Neuronal Tumors
DNT
Benign quasi hamartomatous tumor
Childhood and early adult
Excellent prognosis
Supratentorial, intracortical : Temporal lobe
long history of Intractable seizure
Multinodular, adjacent cortical dysplasia
Biopsy : resemble oligodendroglioma
Floating neuron, mucin rich cortical nodule
No cortical/subcortical invasion
Embryonal tumors/
Primitive Neuroectodermal tumors
Schwannoma (NF2)
Neurofibroma (NF1)
Schwannoma (neurilemoma)
(WHO grade I)
Peak 40 y/o
VHL disease
Benign, highly vascular tumor
Most common : cerebellum, spinal cord, retina
Cystic tumor with enhancing mural nodule
VHL gene on 3p25-26 (tumor suppressor)
Renal cell carcinoma, pheochromocytoma
Craniopharyngioma (WHO grade I)