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Anatomical Pathology RCPA Part 2 > CNS > Flashcards

CNS Flashcards

1
Q

benign mimics of malignancy

A

radiotherapy

infarcts

demyelination

infection

gliosis

pineal cyst (adjacent gland is cellular)

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2
Q

infarcts - check for…

A

thrombi/emboli

amyloid

vasculitis

hypertension

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3
Q

demyelination

A

MS

PML

central pontine myelinolysis

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4
Q

infections

A

JC virus

HSV (esp temporal lobe)

CMV

cryptococcus

toxoplasmosis

cysticercosis

hydatid cyst

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5
Q

malignant mimics of benign

A

LG diffuse astrocytoma

germinoma with inflammation

haemorrhage/necrosis in a tumour

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6
Q

nearly normal brain

A

vessels: amyloid angiopathy, vasculitis, hypertension, emboli
degenerative: Alzheimers, Lewy body
infection: spongiform encephalopathy
tumour: intravascular DLBCL
other: hippocampal sclerosis, pituitary apoplexy

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7
Q

HIV encephalopathy

A

encephalitis (microglial nodules with giant cells)

leukoencephalopathy (diffuse demyelination)

infection

malignancy

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8
Q

foamy macrophages

A

demyelination

infarct

infection

lymphoma (treated with steroids)

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9
Q

granulomas

A

infection

sarcoid

vasculitis (CNS or systemic)

germinoma

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10
Q

cysts (categories)

A

glial

ependymal

arachnoid

epithelial

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11
Q

epithelial cysts

A

Rathke cleft: sellar, resp or non-keratinising sq epithelium

colloid: 3rd ventricle/FOM, cuboidal +/- cilia
dermoid: midline, keratinising sq, sample to exclude teratoma
epidermoid: more lateral, keratinising sq

foregut cyst: anterior spinal cord, mucinous or resp epithelium

cystic neoplasm

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12
Q

glial cysts

A

pineal

simple (cerebellum)

syrinx (spinal cord)

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13
Q

cystic neoplasm

A

craniopharyngioma

pilocytic astrocytoma

PXA

ganglioglioma

haemangioblastoma

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14
Q

papillary craniopharyngioma vs epidermoid cyst

A

CP: sellar/suprasellar, no keratin/granular layer

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15
Q

grading (atypical/anaplastic forms)

A

anaplastic astrocytoma: 2/3 mitoses/10HPF (no MVP or necrosis)

atypical meningioma: 4 (or other criteria)

anaplastic ependymoma: 5 (+/- MVP and necrosis)

anaplastic oligodendroglioma: 6 (+/- MVP and necrosis)

anaplastic meningioma: 20

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16
Q

atypical meningioma

A

4 or more mitoses per 10 HPF

or

brain invasion

or

3 of: cellularity, small cells, prominent nucleoli, sheeting, necrosis

17
Q

papillary neoplasms

A

papillary ependymoma (GFAP+)

choroid plexus papilloma (transthyretin+, CK+, EMA-)

papillary meningioma (EMA+)

metastatic ca (EMA, CEA+)

18
Q

genetics for classification

A

astrocytoma/glioblastoma: IDH

oligodenroglioma: IDH, 1p19q
ependymoma: RELA fusion (supratentorial only)
medulloblastoma: WNT-activated, SHH-activated +/- TP53, nonWNT/nonSHH (GAB1, YAP1 and b-catenin as surrogates)

diffuse midline glioma: H3 K27M mutation

19
Q

metastases

A

melanoma

carcinoma: lung, breast, kidney, thyroid, colon

20
Q

AVM vs cavernous angioma (both cause seizures and haemorrhage)

A

AVM: artery-vein connections, varied wall thickness, abnormal elastic lamina, intervening gliotic brain

CA: compact thin- or thick-walled vessels

21
Q

gliosis vs diffuse astrocytoma

A

astrocytoma: radiology, nuclear atypia, clustering, p53/ki67

22
Q

infarct vs demyelination

A

demyelination:

loss of myelin (LFB) (also lost in infarct)

preserved axons (Bielschowsky silver or NF)

foamy macrophages (CD68)

23
Q

chondromyxoid lesions of CNS

A

chordoma (sacrum and clivus): cords+physaliferous cells, CK/EMA/s100/brachyury+

myxopapillary ependymoma (cauda equina): papillary with hyalinised vessels, GFAP+ EMA-

chordoid meningioma (dura): whorls/inclusions/psammoma bodies, CK- EMA+

chondrosarcoma: malignant cartilage, s100+/- EMA/GFAP-

24
Q

schwannoma vs fibrous meningioma

A

both s100+

meningioma: EMA+

25
Q

meningioma vs SFT vs HPC

A

SFT/HPC: both STAT6+ CD34+

HPC: high cellularity, diffuse reticulin network

SFT: patternless, hypo and hypercellular, collagen fibres, focal reticulin

26
Q

haemangioblastoma vs RCC

A

haemangioblastoma: inhibin, CD56+

RCC: CD10, CK, PAX8+

27
Q

glioma biomarkers

A

IHC:

IDH R132H: + in secondary GBM, and diffuse oligo/astro (required for new WHO categories; do IDH sequencing if - ) - better response to therapy

ATRX: usu lost in diffuse astro (cf oligo)

P53: diffuse astro (cf oligo)

Ki67

BRAF V600E: suggests PXA or GG (cf diffuse gliomas)

(also Olig2: marker for diffuse gliomas (not just oligodendroglioma))

FISH:

1p19q: oligodendroglioma

EGFR ampl: wild type glioblastoma

10q23 (PTEN) del: wild type glioblastoma

Diagnostic genetics:

MGMT promoter methylation (by PCR): better response of GBM to temozolomide (cos no DNA repair)

BRAF mutation

28
Q

DDX non-traumatic bleed

A

hypertension

CAA (do beta-amyloid stain in all bleeds over 50!)
anticoagulation/coagulopathy

AVM/aneurysm

tumour

29
Q

DDX hyalinised vessels

A

amyloid

hypertension

vasculitis

radiotherapy

Anatomical Pathology RCPA Part 2 (30 decks)

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