TUMORS Flashcards
AGE RELATED DISTRIBUTION OF TUMORS
IHC ASSOCIATED WITH TUMORS
Regional Distribution of Common Neuroepithelial Tumors
A well adjusted lively and sociable woman had her fi rst tonic-clonic seizure at 33 years of age. One year later, she was evaluated for headaches and, around the same time, her behavior gradually changed: She became withdrawn, uncommunicative, spent the days in bed, neglected her appointments with her psychiatrist, and obstetrician. Following delivery of a healthy child, her condition rapidly deteriorated, she appeared catatonic, and died a few weeks later.
A. The convolutional pattern of the left frontal lobe is effaced by a soft homogenous grayish mass lesion.
B. The white matter of both frontal lobes, the corpus callosum, and the caudate are diffusely enlarged by a poorly demarcated, soft, gelatinous, pinkish-gray tumor that contains tiny cystic cavities.
C. The tumor is moderately cellular, composed of neoplastic protoplasmic astrocytes showing mild nuclear pleomorphism (HE). Blood vessels are sparse; mitoses and necrosis are absent
Diffuse protoplasmic astrocytoma
WHAT CHANGE IN PT WITH ASTROCYTOMA?
A and B. A poorly demarcated, fi rm grayish tumor diffusely enlarges the right basal ganglia, both thalami, and upper brainstem and (C) extends extraparenchymally above the midbrain tectum. D. The tumor is composed of neoplastic astrocytes showing a mild nuclear pleomorphism and dense, elongated fi brillary processes which fi ll the intercellular spaces. The neuronal pattern of the infi ltrated gray structures is generally preserved (HE).
Fibrillary astrocytoma in an 11-year-old girl
A. It consists of
large, plump, neoplastic astrocytes with
glassy pink cytoplasm and eccentrically
placed nucleus (HE). B. The cells strongly
react for GFAP (immunostain
Gemistocytic astrocytoma in the wall
of the third ventricle
A 35-year-old man, about 3 weeks prior to his death, developed severe, persistent headaches and gradually became confused and disoriented. Bilateral papilledema was the only signifi cant neurologic fi nding.
A. A large hemorrhagic tumor fi lls the anterior horns, destroys the septum and fornices, and extends into the walls of the third ventricle.
B. It is highly cellular. The neoplastic cells have large hyperchromatic nuclei and variable amounts of cytoplasm. Bizarrely-shaped multinucleated cells are occasionally seen (HE).
Anaplastic astrocytoma
A 7-year-old girl had a 3-week history of headaches, vomiting, right extremity weakness, and somnolence.
Examination revealed bilateral papilledema, right hemiparesis, impaired touch and pain sensations, and asterognosis in
the right hand, which was in an athetoid-like posture.
A. A large, soft, grayish tumor diffusely enlarges the left thalamus. B. The tumor is highly cellular, with moderately large pleomorphic astrocytes. C. Intermixed are larger multinucleated cells
(HE)
Anaplastic astrocytoma
A 57-yearold right-handed man experienced three episodes of incoherent speech for several hours within 1 month prior to hospitalization. His past medical history was signifi cant for old head injuries. A. Contrast-enhanced T1- weighted MRI shows a left temporal tumor surrounded by massive edema. The tumor was resected and histologically diagnosed as glioblastoma. The surgery was followed by radiation therapy. B. A postoperative CT scan shows total resection of the tumor and resolution of the edema. C. Nonetheless, one year later, a CT scan shows recurrence of the tumor with massive edema. A few months later, he died. D. An extensive necrotic tumor occupies the left
temporo-occipital region
GBM
A. A grayish, fi rm, relatively circumscribed tumorous infi ltration obscures the temporal convolutions. B. On
transverse section, the tumor contains fresh hemorrhages and viable tumor in the cortex.
GBM
A. Densely populated area of small, poorly differentiated glial cells (HE). B. Fusiform cells forming loose bundles displaying large atypical glial cells (HE). C. Giant mononucleated and multinucleated glial cells (HE).
D. Some tumor cells express GFAP (immunostain). E. Atypical mitotic fi gure (HE).
GBM
VASCULAR FEATURES OF GBM
A. Endothelial capillary hyperplasia. B. Glomeruloid capillary proliferation
PATTERN OF GBM NECROSIS
Serpiginous areas of necrosis are surrounded by pseudopalisading tumor cells.
A 2.5-year-old boy with unremarkable history developed infantile spasms and began to mentally deteriorate.
At age 7, a large right temporoparietal mass lesion was diagnosed and parts of it—60 g—were resected. He received no radiation therapy. Following a temporary improvement, he developed seizures and slowly deteriorated.
At age 13.5, following an 11-year clinical course, he died. A. A huge, fairly well-demarcated tumor occupies the temporal lobe and greater part of the hemisphere. B. Anteriorly it contains a large cyst. C. Astrocytes with uni- and bipolar processes form a fi brillary matrix around
a capillary. D. Rosenthal fi bers are abundant in some areas
Pilocytic astrocyTOMA
A 47-year-old man presented with a 2-month history of left-sided partial sensory seizures. Six months earlier, he experienced a short episode of left-sided weakness and loss of consciousness followed by confusion. A. Axial T2- weighted MRI shows a large inhomogeneous hyperintense right temporoparietal tumor extending into the basal ganglia. B. The partially resected tumor is composed of oligodendrocytes with round and oval nuclei and clear (halo) cytoplasm (fried egg appearance) (HE).
ODG
COMPONENTS OF ODG
(A) great uniformity of the tumor cells, (B) dense calcifi cations in the cerebral cortex, and (C) microgemistocytic components (HE).
A circumscribed cherrysized, firm, lobulated tumor fi lls the lumen of the fourth ventricle. B. Macrosection of
the tumor at pontine level (cresyl violet).
Ependymoma of the fourth ventricle in a 54-
year-old man
A. Cuboidal ependymal cells fi ll the lumen of the lateral ventricle. The cells are uniform in appearance and are
arranged in sheets or show no particular pattern (cresyl-violet).
B. Papillary pattern (HE).
C. Perivascular pseudorosettes. Some cells express GFAP (immunostain).
EPENDYMOMA
A. A small tumorous nodule is attached to the wall of the lateral ventricle, incidental autopsy fi nding (HE)
B. Nests of tumor cells are situated in a fi brillary matrix (HE stain
SUBEPENDYMOMA
A nut-sized
amount of soft, bluish tissue removed from the
cerebellopontine angle consists of cuboidal epithelial
cells resting on fi brovascular core (extracerebral
portion of the plexus of the fourth
ventricle) (HE). B
Choroid plexus papilloma
A. Highly cellular tumor of pleomorphic columnar epithelial cells forming several rows on fi brovascular cores. B. Tumorous infi ltration around the cerebellum (HE) and (C) optic nerve
(LFB-CV).
Choroid plexus carcinoma with extensive dissemination
A. Midsagittal sec tion of the cerebellum shows a large tumor arising from the vermis and fi lling the lumen of the fourth ventricle. Small tumor nodules are present in the cerebellar cortex, indicating dissemination via CSF (cresyl violet).
B. Highly cellular tumor consists of anaplastic cells with small round to oval hyperchromatic nuclei surrounded by scanty cytoplasm (HE).
C. Pale island in nodular variant (HE).
D. A desmoplastic variant in the cerebellar
hemisphere (cresyl violet
Medulloblastoma
An 11-year-old girl presented with a 1-week history of headaches, vomiting, and confusion. She had a stif
neck, papilledema, slowly reacting pupils, and vertical gaze palsy (Parinaud syndrome). She died of hypothalamic dysfunction 2 weeks following a shunting procedure. An egg-sized pineal gland tumor compresses the midbrain tectum and extends into the third ventricle. It is loosely attached to the wall of the ventricle.
B. The tumor cells, resembling pineocytes, form groups
separated by mesenchymal septa (HE).
A. Pineocytoma
A. Macrosection of the tumor (HE). B. The tumor fi lls the posterior part of the third ventricle
(LFB-CV). C. Small seeding tumorous nodule in subarachnoid space consists of small cells with round-to-oval hyperchromatic
nuclei (HE). D. The cells immunoreact for synaptophysin. E. Small tumorous nodules in the substantia nigra (HE).
Pineoblastoma in an adult male.
A. A small, round encapsulated parasagittal meningioma is loosely attached to the leptomeninges. It indents but
does not invade the underlying cortex (HE). B. A large, lobulated falx meningioma slightly indents the corpus callosum. C. A
huge olfactory groove meningioma presented with psychiatric symptoms in a 43-year-old woman. The olfactory nerves are
embedded in the tumor, and the chiasma and hypothalamus are displaced caudally. D. A left medial sphenoid wing meningioma
on sagittal noncontrast T1-weighted MR image appears as an extra-axial isointense mass lesion. It is presented in a 58-year-old
man with progressive loss of vision in the left ey
MENINGIOMA
HISTO FEATURES OF MENINGIOMA
A and B. Meningothelial (syncytial) meningioma. Moderately large, oval nuclei are surrounded by round or polygonal cytoplasm with poorly defi ned borders. The cells typically are arranged in whorls (HE).
C. The center of some whorls display a psammona body (HE).
D. Fibrous meningioma consists of fi brillated spindle cells arranged in interlacing bundles (HE).
E. The tumor cells immunoreact for vimentin (immunostain). F. Bony invasion by meningioma (van
Gieson stain).
(A) with small elongated cells (HE) (B) in a rich reticulin network (reticulin stain).
Hemangiopericytoma showing a high cellularity
WHAT IS STHIS
Primary meningeal sarcomatosis in a 15-year-old girl diffusely
spreads into the subarachnoid space and invades the
cerebral cortex (Cresyl violet).
Melanin-containing cells infi ltrate
the leptomeninges and the parenchyma along the Virchow-
Robin spaces (HE).
Meningeal melanocytosis
Hormones secreted by anterior pituitary adenomas
A. The cells are separated into
groups by sinusoidal tabeculae. B. They
display a small nucleus, variable amount
of cytoplasm, and slight pleomorphism
Pituitary chromophobe (null-cell) adenoma.
A. The tumor in the pineal region infi ltrated the midbrain (myelin stain). B. Moderately large tumor cells with clear cytoplasm and prominent nucleus are separated into lobules by fi brous septa that contain large collections
of lymphocytes (Cresyl-violet.)
Germinoma
A. Cherry-sized encapsulated
tumor in the right cerebellarpontine angle.
The tumor displays histologic features of Antoni
types A and B. B. Spindle-shaped bipolar cells
form fascicles and show palisading, with alternating
zones of nuclei and processes. C. Verocay
body, Antoni type B. D. Small stellate cells are
situated in a loose matrix (HE
acoustic neuroma
WHAT IS THIS?
A. Peripheral nerve neurinoma (myelin stain). B. Intradermal
neurinomas (van Gieson stain).
The tumor shows great
hypercellularity, with spindle-shaped cells forming bundles,
nuclear pleomorphism, and multinucleated giant cell.
MPNST
A 55-year-old woman presented with headaches and declining memory of 3 years’ duration and excessive daytime sleepiness of 1 year’s duration. On examination, the optic discs were pale, and the visual acuity severely diminished. She lay motionless and speechless with a vacant expression, resembling akinetic mutusim. Her temperature was intermittently elevated, and she needed to be spoon-fed.
A. Sagittal section of the brain shows a large cyst with small tumorous mural modules. The cyst is loosely attached to the infundibulum, compresses the diencephalons, and obliterates the third ventricle. The lumen is fi lled with machine-oil–like material.
B. The mural nodules consist of squamous epithelial cells arranged in small islands
(adamantinomatous pattern) (HE).
CRANIOPHARYNGIOMA
A. A contrast CT scan shows a large cystic mass within the third ventricle. B. Macrosection within the third ventricle (LFB-CV). The mural nodules contain (C) squamous epithelial cells and (D.) homogenous keratin material. E. The cyst wall is loosely attached to the ventricular wall; it contains astrocytic fi bers and Rosenthal fi bers (HE).
CRANIOPHAR
A. A large cystic tumor situated in the pineal region compresses the tectum and the aqueduct. It breaks into the third and enlarged lateral ventricles. Small fragments of glossy material are deposited on the ventricular wall. B. The cyst wall consists of squamous epithelial cells, and the lumen contains keratin arranged in concentric lamellae. C. The ventricular wall shows epedymitis with foreign-body giant cells.
Epidermoid cyst in a 33-year-old mentally retarded epileptic man
A 35-year-old woman who suffered from severe headaches died suddenly. Transverse section at the thalamus level shows a cherry-sized colloid cyst blocking the foramen Monro. The lateral ventricles are moderately
dilated. Separation of corpus callosum is artifactual
Colloid cyst of the third ventricle.
WHAT IS THIS
Lipoma associated with agenesis of the corpus callosum.
A. Macrosection of the cerebellar hemisphere shows a large cyst with a small tumorous mural nodule.
B. The tumor consists of endothelial cells lining capillary channels and (C.) large foamy stromal cells that contain lipid (HE).
Capillary hemangioblastoma
WHAT ARE THESE?
Vascular malformations. A. Cavernous angioma (van Gieson). B. Arteriovenous malformation. Hemosideum pigments are scattered
around the lesion. C. Capillary telangiectasis (HE).
WHAT ARE THESE?
A. Contrast-enhanced CT scan shows bilateral hemispheric mass lesions in the genu and body of corpus callosum and periventricular white matter. Biopsy of the tumor shows (B) large B-cell lymphoma with (C) perivascular arrangement of tumor cells (HE stain). D. Concentrically arranged reticulin fi bers encircle the tumor cells (reticulin
stain), which (E) immunoreact for CD2O B-cell marker.
PCNSL
DETERMINE THE TYPE OF SC TUMORS
A. Intramedullary ependymoma (myelin stain).
B and C. Histology of mixopapillary ependymoma (HE).
D. Intramedullary angiomatosis (Perdrau stain). E. Schwannomas of the nerve roots (myelin stain). F. Carcinoma metastasis
(cresyl violet).
Following a resection of a primary lymphoma, he received fi rst a total dose of 5,000 rads and, 2 years later, a total does of 3,800 rads. Macrosection from the cerebral hemisphere shows cavitated white matter, areas of coagulative necrosis, and preservation of the cortex (HE).
Late delayed radiation leukoencephalopathy in a 64-year-old man.
