Neuropathology 4- Metabolic Diseases And Cns Tumors

Front 1

Wernicke's encephalopathy:
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Back 1

-Thiamine deficiency

-Lesions that appear hemorrhagic, but are actually proliferation of small vessels.

-These are dispersed throughout the MBs and hypothalamus.

-Involvement of the DM thalamus leads to confabulation; condition gets called WKS at this point.

-Neuronal loss and gliosis of affected areas is also present.

-Atrophy of cerebellum

Front 2

Hepatic Encephalopathy:

Back 2

-Damage to the brain resulting from hepatic encephalopathy occurs because of elevated ammonia levels that impair oxidative metabolism.

-The brain shows diffuse edema, as well as proliferation of so-called ALZHEIMER TYPE II ASTROCYTES. These cells are characterized by a central clearing of their nucleus
and a red, spotty nucleolus.

*common with etoh abuse, but can be caused by other things.

Front 3

Vit B12 deficiency:

Back 3

-Nutritional deficiency of cobalamin leads to degeneration of axons and demyelination of the
DORSOLATERAL regions of the spinal cord.

-Characteristically spares the anterior columns.

Front 4

-histologically malignant

-biologically malignant

Back 4

(1) histologically malignant: dysplastic and/or anaplastic biopsy features.

(2) biologically malignant – benign tumors that are not
resectable but because of mass effects could be fatal.

Front 5

1˚ intracranial tumors:

1˚ brain tumors:

Back 5

Primary intracranial tumors: primary tumors in the cranial cavity

Primary brain tumors: arise from constituents cells of brain not including non-brain intracranial tissue (i.e. meningiomas) and metastatic tumors

Front 6

Astrocytoma and Glioblastoma Multiforme:
prevalance
age at presentation

Back 6

80% of adult primary brain tumors
most common in late middle age
divisible into 4 grades

Front 7

Describe Astrocytoma Grade II: 4

Back 7

-poorly defined; hard to see where it starts/ends.

-infiltrative; µscopic spread very common, aggressive.

-uniform population of cells containing a variety of astrocytic conformation (protoplasmic, fibrillary or gemistocytic)

-marked tendency to become more anaplastic with time

Front 8

Satellitosis:

Back 8

Astrocytomas show a subtle increase in the number of astrocytes. These tend to surround
neurons – a finding called SATELLITOSIS. The proliferative astrocytes tend to crowd one another and
show loss of contact inhibition.

Front 9

Anaplastic astrocytomas:

Back 9

Show increases in pleomorphism and mitotic figures as well as a generalized hypercellular appearance.

Front 10

Glioblastoma:

Back 10

Like an anaplastic astrocytoma with necrosis.

Front 11

Pilocytic Astrocytoma:
histologic traits 4
behavior
prognosis

Back 11

-often cystic

-protoplasmic astrocytes (bipolar cells with “hair-like” processes

-Rosenthal fibers (eosinophilic bodies formed in astrocyte processes)

-vascular endothelial proliferation- does not imply unfavorable prognosis

-slow growing; act like hamartomas

-prognosis pretty good.

Front 12

oligodendoglioma:

prevalance
age at presentation
locations in brain
histologic traits 4
prognosis

Back 12

-5% of all gliomas

-middle age

-cerebral hemispheres

-well circumscribed

-focally hemorrhagic

-calcification

-microscopic: sheets of cells with spherical nuclei surrounded by halo of cytoplasm

-up to 50% contain areas of astrocytoma that determines prognosis

-Can progress into a glioblastoma (same progenitor cells) and kill you

Front 13

ependymomas
prevalance
age at presentation
locations in CNS
histologic traits
prognosis

Back 13

-typically fourth ventricle; usually present with hydrocephalus

-5-10% of primary brain tumors in first two decades of life

-in middle age spinal cord is most common location

-large percentage of primary intraspinal neoplasms of middle age

-typically solid or papillary masses projecting from floor of ventricle

-intraspinal tumors are sharply demarcated making total resection possible; not responsive to chemo/rad.

Front 14

Choroid plexus papilloma:

Back 14

most common in lateral ventricles of children

in adults frequently found in the fourth ventricle

microscopic: recapitulate normal choroid plexus with

marked papillary growth

Front 15

Medulloblastoma:
prevalance
age at presentation
locations in CNS
histologic traits
behavior
prognosis

Back 15

-cerebellum

-first few decades of life

-25% of all primary brain tumors in this age group

-typically in vermis of cerebellum

-frequently disseminate through the CSF

-microscopic: densely cellular
pleomorphic nuclei with little cytoplasm
Homer Wright rosettes

-capacity for both glial and neuronal differentiation

-origin may be external granular layer of cerebellum

-10 year 50% survival with surgery and radiotherapy

Front 16

Pseudorosettes:

True rosettes:

Back 16

When cancer cells seem to cluster around a central vessel; often seen in EPENDYMOMA.

-AKA HOMER-WRIGHT rosettes; often seen in Medulloblastoma and Neuroblastoma; differentiated tumor cells surround the neuropil.

Front 17

meningioma:

prevalance
age at presentation
locations in CNS 4
histologic traits
behavior
prognosis

Back 17

-arise from arachnoid cap cells

-20% of all primary intracranial tumors

-locations: convexities
falx cerebri
lesser wing of sphenoid
olfactory groove

-middle and older aged

-3:2 ratio of women to men

-rapid growth during pregnancy

-sex hormone receptors

-Have a dural tail; distinguishes from a met.

Front 18

Metastatic Tumors:

prevalance
origin 5
type of cancer they arise from
histologic traits
behavior
prognosis

Back 18

-25-30% of intracranial tumors
-majority are carcinomas
lung
breast
skin (melanoma)
kidney
gastrointestinal

-choriocarcinoma- rare, but frequently metastasizes to brain

-gray-white junction, sharply demarcated
-surrounding zone of edema
-microscopic recapitulates primary (look the same)
-surgery

Front 19

Metastatic neoplasms involving CNS:
-location in brain
-what locations are rarely involved?
-posterior fossa mets common from what cancers?
-what blood distribution is commonly involved?
-when is hemorrhage prominent?

Back 19

-take origin in well vascularized gray matter

-8:1 ratio of cerebrum to cerebellum

-brainstem rarely involved

-posterior fossa metastasis frequently from GI tract, bladder and uterus (via Batson's plexus)

-brain supplied by middle cerebral artery preferentially involved (due to sheer volume)

-hemorrhage is especially prominent in melanoma and choriocarcinoma

Front 20

carcinomatous meningitis:

Back 20

-Another disturbing feature of metastatic tumors is their ability to invade the CSF.

-If given access to the ventricular system, these tumors can irritate the meninges, producing CARCINOMATOUS MENINGITIS.

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