CENTRAL NERVOUS SYSTEM  Bright enhancing ring

 No BBB interruption
 Hypodensity area
(Central necrosis)
-zones of coagulative necrosis lined by
‘palisading tumor cells’
 Primary- de novo -older patient - mean 55 years
-short clinical history- <3 months
-EGFR amplification / overexpression
- ‘tumor bad from the start’
•Short, rapidly progressing course
•No pre-existing low grade
astrocytoma
 Secondary - malignant progression of diffuse
astrocytoma
- ‘tumor gone bad’
•Younger patient
•p53 mutation
PILOCYTIC -WHO grade I
CNS TUMORS ASTROCYTOMA - Rarely with p53 mutation
Metastases - Most common -Children and young adults – peak
Menigeal - derived from epithelial cells of the -incidence 10-12 years
meninges, “meningiomas” -slow growing, relatively benign
Neuroepithelial - loosely termed “gliomas” which are -rare malignant progression
derived from astrocytes, oligodendro -cerebellum, optic nerve, third
cytes, ependyma, neurons or primitive ventricle, cerebral hemisphere
embryonal cells -process-bearing spindle cell (‘piloid’)
Non-epithelial - includes cerebral lymphomas, GCT, constituents fashion a densely fibrillar
cysts and tumors extending from local matrix
growth in the skull and pituitary -process-poor (‘protoplasmic’)
elements aggregate in regions of
Common ADULT tumors myxoid change that often progress to
Astrocytomas (diffuse type) microcyst formation.
Meningiomas - Solid
Oligodendrogliomas -brightly contrast
CNS lymphomas PLEOMORPHIC -WHO grade II
Metastatic Carcinoma XANTHOASTRO -presents in later childhood or early
Common CHILDHOOD tumors CYTOMA adult life
Medulloblastoma -cerebral hemispheres(temporal lobes)
Pilocytic astrocytoma -Also: cerebellar intramedullary intra
Ependymoma sellar, and retinal
Choroid plexus papilloma -sharply delimited
Ganglioglioma -intensely and homogenously contrast
TUMORS - Spindle and giant cells
GLIOMAS most common group of primary brain - bizarre multinucleated forms
tumors - (+) lipid accumulation
• astrocytomas SUB EPINDYMAL -1ST or 2nd decade of life
• oligodendrogliomas GIANT CELL -associated w/ obstructive hydro
• ependymomas ASTROCYTOMA cephalus
DIFFUSE -Up to 80% of adult primary brain -Near foramen of Monro
ASTROCYTOMA tumor -restricted to the setting of tuberous
-p53 mutation sclerosis
-progression from low to high grade - large, closely apposed and polygonal
 Fibrillary DA Most common rounded, or spindly
- 3rd to 4th decade of life -eosinophilic cytoplasm often has a
- cerebral hemispheres glassy or hyaline appearance
- Headaches, seizures, focal -eccentrically positioned, vesicular
sensorimotor deficits, and alterations nuclei
of affect -prominent nucleoli
 Diffuse gyral expansion -intersecting fibrovascular stroma
 Effacement of landmarks Oligodendroglial Tumors
 No discrete mass is formed Oligodendroglioma -marked nuclear atypia and occasional
 (-)hemorrhage or necrosis mitosis are allowable
 Conspicuous cytoplasmic - 5-15% of gliomas
processes -4th to 5th decade of life
 mild nuclear pleomorphism -Mainly cerebral hemisphere
 modest hyperchromasia -1p and 19q deletion
 absence of mitotic activity – good response to radio- and
 dyscohesive growth pattern chemotherapy
ANAPLASTIC -WHO grade III -Better prognosis than astrocytomas
ASTROCYTOMA -Amplification of EGFR - linear or plate-like calcifications-
-increased cellularity most suggestive of the diagnosis.
-cytologic features of a fully malignant - Perinuclear clearing – fried egg
neoplasm appearance
-(+)mitotic figures -With granular cytoplasm
GLIOBLASTOMA -WHO grade IV -Delicate anastomosing capillaries
-most aggressive of the infiltrating -Chicken wire pattern
astrocytic tumors -GFAP- positive

CGAtienza
Anaplastic •significant mitotic activity Three or more of the following:
oligodendroglioma •prominent microvascular proliferation •increased cellularity
(Grade III) •conspicuous necrosis •small cells with high N:C ratio
-complex microvascular proliferation •prominent nucleoli- macronucleoli
-dense cellularity •uninterrupted or sheet like growth
-obvious nuclear atypism •necrosis
Ependymoma -WHO grade II Anaplastic “hallmark of frank malignancy far in
-5 – 10% of childhood brain tumor (Malignant) excess of the abnormalities”
-4th ventricle in children & Meningioma defined as:
adolescents (1) containing 20 or more mitoses per
-Spinal cord in adults- 10 high-power microscopic fields
- Round to oval nuclei, granular (2) exhibiting a loss of differentiated
chromatin features resulting in carcinoma-
-Fibrillarity melanoma-, or sarcoma-like
-Resemble central canal appearances
-Perivascular pseudorosettes Primary CNS - 2% of extranodal lymphoma
Choroid Plexus Benign –WHO grade I Lymphoma -1% of intracranial tumors
Papilloma Most common in children -Adults and immunosuppressed
-Lateral ventricles and 4th ventricle -Deep cerebral hemispheres – gray or
(+)Hydrocephalus white matter – does not cause seizure
•Increase CSF production -usually B cell lymphomas (immunoblastic)
•Obstruction to CSF flow -radiosensitive but poor prognosis
- friable mass - tumor cells to aggregate in Virchow–
-villiform or bosselated surface Robin spaces and to infiltrate the walls
(cauliflower like) of cerebral vessels
-Calcification is common -associated with reticulin deposition in
-gritty consistency or stony hardness concentric, ring-like pattern
- complex array of branching fibro Metastatic - Secondary involvement of the CNS
vascular fronds Carcinoma -direct extension or hematogenous
-minimal nuclear atypism metastasis .
MEDULLOBLASTOMA - MC of primitive neuroepithelial REMEMBER!!!!
neoplasms  A. Astrocytoma- less circumscribed
-WHO grade IV  B. Diffuse large B-cell lymphoma- in AIDS, - GFAP
-peak 5 and 10 years of age  C. Germ cell tumor- most in pineal body
- Exclusively cerebellar location (At  D. Glioblastoma multiforme- highly aggressive
least 75% arise in the cerebellar vermis)  E. Medulloblastoma- children, posterior fossa
-(+)obstructive hydrocephalus  F. Metastatic renal cell carcinoma
-Loss of 17p, isochromosome 17q  G. Oligodendroglioma
-solid masses of friable, gray–white
tissue
 Higly cellular
 Nuclei are often densely
hyperchromatic, round or Instead of looking at the hundred reason to quit,
angulated
 little or no definable cytoplasm look at the thousands reasons NOT TO GIVE UP
 Abundant mitotic figures
MENINGIOMA -middle or later adult life
-F>M
-increased prevalence in women with
mammary carcinomas
- thickened and abnormally enhancing
dural “tails” extending from the
lesional borders (suggestive finding, though
not diagnostic)
 Meningothelial cells in nests and
whorls
 Psammoma bodies – calcification
 Indistinct cytoplasmic boundaries
 nuclear clearing (pseudoinclusions)
 cellular whorls
 Grading •WHO grade I – benign
•WHO grade II – recurrence prone
•WHO grade III - anaplastic
 Fibroblastic type -Cellular spindling
-fascicular or storiform architecture
 Secretory ‟pseudopsammoma bodies‟ – globular
meningioma hyaline inclusions that are eosinophilic
 Clear cell -cytoplasmic clearing, traversing
meningioma collagenous bands
- (-)meningothelial-type whorls.
 Papillary -ependymoma-like perivascular stx
meningioma -elongated cytoplasmic processes
toward vessel walls, fashioning
pseudorosette-like structures that
disaggregate and come to float
unanchored in tissue sections
Atypical Meningioma -Increased mitotic activity
•4 or more per 10 HPF or

CGAtienza