By Richard A. Prayson
The scope of neuropathology maintains to extend and the ever-increasing quantity of knowledge to assimilate and grasp should be daunting. Neuropathology overview, moment variation summarizes in basic define shape the necessities of neuropathology. it's been up-to-date to mirror the most recent details and concepts during this consistently altering field.
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Anaplastic oligodendroglioma • WHO grade III tumor • Pleomorphic nuclei • Mitoses, often > 5 per high-power fields • Vascular proliferation • Necrosis • Increased cellularity • Worse prognosis than low-grade tumor, median survival 3–4 yr • Rarely can see “glioblastoma multiforme” derived from oligodendroglial tumor • 1p and 19q chromosome deletions associated with increased likelihood of chemoresponsiveness C. Mixed glioma • Clinically and radiographically similar to astrocytomas and oligodendrogliomas • Most frequently a mixture of astrocytoma and oligodendroglioma (oligoastrocytoma), 20–30% minor component • May have anaplastic tumor components present (malignant mixed glioma) • A subset of tumors have genetic alterations similar to oligodendroglioma • Prognosis may be intermediate between pure oligodendroglioma and astrocytoma • Rarely see mixtures of other glioma types (oligoependymoma and ependymoma— astrocytoma) D.
Pituitary adenoma • About 10–20% of all intracranial neoplasms • Most common in adults • Women most often affected • Seen incidentally in approximately 25% of autopsies • Microadenoma <1 cm in diameter • Symptoms: related to endocrine dysfunction or visual disturbance • Most common secreting adenoma—prolactinoma • Microscopic pathology ◦ Heterogeneous histologic appearance ◦ Patterned sheets of uniform cells with a delicate vascular network ◦ Nuclei are round and have a delicate chromatin pattern ◦ Cells often have granular cytoplasm ◦ Lacks the normal acinar or lobular pattern of the pituitary ◦ Monotonous cell types ◦ Immunohistochemical staining for pituitary hormones will identify the secretory products • Rare examples of pituitary carcinoma (defined by noncontiguous spread) • Apoplexy—sudden enlargement of adenoma related to infarct/hemorrhage 32 NEUROPATHOLOGY REVIEW F.
Ependymoma • WHO grade II tumor • 5–10% of tumors, children • 1–2% of brain tumors, adult • Any ventricle (especially 4th) and spinal cord (intramedullary) • 71% infratentorial • Obstruction of CSF-related signs and symptoms at presentation • Grossly: soft lobular, discrete mass, well demarcated • Microscopic pathology ◦ Extreme fibrillarity ◦ Nuclei round to oval, “carrot-shaped” ◦ Dense nuclear chromatin ◦ Slight nuclear pleomorphism C. Anaplastic ependymoma • WHO grade III tumor • Rare • Precise histologic criteria to distinguish from ordinary ependymoma is not well defined • Increased mitoses • Nuclear and cellular pleomorphism • Hypercellularity • Endothelial proliferation • Focal necrosis frequent D.