Central Nervous system

Question 1

The central nervous system includes?

Answer 1

Brain
Spinal cord
CSF

Question 2

Red blood cells in the CSF indicate?

Answer 2

Haemorrhage

Question 3

CSF showing first neutrophils and later haemosiderin-laden macrophages

Answer 3

Infarction

Question 4

CSF showing mild cellular increase, lymphocytes and

histiocytes.

Answer 4

Degenerative disorders

Question 5

CSF showing atypical histiocytes

Answer 5

De-myelinating disorders (eg: MS)

Question 6

The CSF protein level is elevated and the glucose normal or decreased

Answer 6

Inflammatory and reactive changes of CSF

Question 7

What is frequently associated with infected ventriculoperineal shunts,
reservoirs for chemotherapeutic agent instillation, parasitic infestation of the CNS
and rarely meningeal carcinomatosis?

Answer 7

CSF eosinophilia

Question 8

What is an indication of bacterial meningitis?

Answer 8

Neutrophils

Question 9

What is an indication of viral meningitis?

Answer 9

Lymphocytes and Monocytes

Question 10

These three pathogens are common causes of bacterial meningitis, especially in
children.

Answer 10

Haemophilus influenzae
Neisseria meningiditis
Streptococcus
pneumoniae

Question 11

Characterized by a lymphocytic pleocytosis, elevated

protein and decreased glucose levels in the CSF

Answer 11

Tuberculous meningitis

Question 12

CSF shows:
Blast cells with a very high N/C ratio are usually seen.

The nucleus can be round or convoluted and irregular, and takes up most of the
cell and only a moderate rim of cytoplasm is seen around it.

Answer 12

Neoplastic lesions

Question 13

Increased numbers of immature blast cells are seen.
 The cells are larger than normal lymphocytes and have a higher N/C ratio.
 The nuclei vary in size and shape.
 Nucleoli are visible and some mitotic figures can be seen.

Answer 13

ALL (Acute lymphoblastic leukaemia)

Question 14

A monotonous pattern of well-differentiated lymphocytes is seen.

A monotonous pattern on a CSF is abnormal and usually points to malignancy.

Answer 14

CLL (Chronic Lymphocytic leukaemia)

Question 15

The cells vary in size and shape with a high N/C ratio.
 The cells may resemble lymphoblasts.
 Some cells have granules in the cytoplasm

Answer 15

AML (Acute myeloid leukaemia)

Question 16

A large number of lymphoid cells are seen with large tumour cells.
 These cells are usually from the large B-cell type and have a fairly aggressive
clinical course.

Answer 16

Lymphoma

Question 17

The most common protozoan infection in brain biopsies

Smears show mature lymphocytes, plasma cells and macrophages amid necrotic
granular or amorphous debris.
 Bradyzooites are recognized as large bag-like structures filled with minute darkly
staining particles.
 These cysts can be very large and may even eclipse macrophages.
 The borders of the bradyzooites can be indistinct so that the encysted parasites
appear as a group of dark small particles mysteriously organised against a
background of debris.

Answer 17

Toxoplasma gondii

Question 18

Infections usually produce brain abscesses following

haematogenous spread of the organism from the gastrointestinal or hepatic foci.

Answer 18

Entamoeba histolytica

Question 19

Smears only show mild increase in cellularity and pleomorphism.
 Cytological preparations are relatively sparse with a fibrillary background
punctuated by oval nuclei

Answer 19

Low grade Astrocytoma

Question 20

Smears show greater cellularity in a retained fibrillary background, marked nuclear
pleomorphism and vascular proliferation, mitotic activity and gemistocytic
astrocytes.

Answer 20

Anaplastic Astrocytoma

Question 21

Cells range from small with scant cytoplasm and hyperchromatic nuclei, to larger cells with pleomorphic nuclei and sufficiently abundant cytoplasm to justify the designation gemistocytic, to indescribably grotesque large bizarre cells.

The cytologic preparation is cellular and retains a fibrillary background.

Pleomorphic tumour cells appear ensnared in this background and may
accumulate near thickened clumps of proliferated vascular channels.

Necrotic debris is often present in variable amounts

Answer 21

Glioblastoma multiforme (high grade glioma)

Question 22

Contains cells with clear cytoplasm, distinct cell
borders, and small round to oval hyperchromatic nuclei.
 Fields of these “fried egg” cells are perforated by small thin-walled vessels and
are punctuated by flecks of calcium.

Answer 22

Oligodendroglioma

Question 23

High cellularity, vigorous mitotic activity,
and focal necrosis.
 These tumours contain a small population of small gemistocytic astrocytes called
minigemistocytes.
 Scant cytoplasm is present, and it is important to recognize that the “fried egg”
cells are artefacts of delayed fixation and are not seen at intraoperative
consultation.
 Thin-walled branching capillaries may be seen in the background

Answer 23

Anaplastic oligodendrogliomas

Question 24

producing
spaces lined by a layer of ciliated cells connected by tight junctions.

Cells arrange themselves around blood vessels producing a paucinuclear zone filled with fibrillary processes immediately around the vessels.

Cytological preparation reveals blood vessels decorated by dense collars of cells
with large round to oval nuclei with pale chromatin and one to two conspicuous
nucleoli.

The cells space themselves from the vessels to form palisades or rosettes with
the long axis of their oval nuclei orientated orthogonal to the vessel wall.

Cells with cilia are infrequently encountered, but detection of these cells is
diagnostic

Answer 24

Ependymoma

Question 25

Cytological examination shows dyscohesive sheets of cells with uniform round
nuclei with finely dispersed chromatin.
 The cytoplasm is sparse and the background has a delicate fibrillary pattern.
 Delicate thin-walled vessels may be seen.
 Calcospherites and patches of fibrillar matrix may separate groups of cells.

Answer 25

Central neurocytoma

Question 26

Cytologic preparation shows smooth spherical clumps of cells corresponding to
the whorls seen in tissue sections.
 Closer examination shows indistinct cell borders and intranuclear cytoplasmic
pseudoinclusions.
 Psammoma bodies may be present in isolation or within balls and sheets of cells

Answer 26

Meningioma

Question 27

Preparation is usually sparse with spindle cells possessing elongated, irregular
vesicular nuclei.
 Mitotic activity is rare and occasional laden-laden macrophages are seen.
 When large fragments of tumour exfoliate or a smear preparation is made,
Verocay bodies may be seen (tumour cells showing nuclear palisades).

Answer 27

Schwannoma

Question 28

Cytologic imprints show large numbers of dyscohesive cells containing large nuclei with moderately coarse chromatin.

Answer 28

Primary lymphoma

Question 29

Abundant exfoliation
 Cohesive clumps of cells
 Hyperchromatic nuclei
 High N/C ratio
 Distinct cell borders
 Sometimes features of differentiation

Answer 29

Metastases

Question 30

Cytological imprints show dyscohesive abundant exfoliation of cells with variable quantities of monomorphic cytoplasm and round to oval nuclei that vary considerably in size and shape.

The chromatin is finely dispersed, occasional mitotic figures are seen and
sometimes the nucleus contains a prominent nucleolus.

Answer 30

Pituitary adenoma