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NEUROPATHOLOGY
NEUROPATHOLOGY
FK UISU
Ischemia
Globally decreased oxygenation of the
brain caused by hypoxia (neardrowning, carbon-monoxide poisoning,
suffocation) or generalized decreased
blood flow (cardiac arrest, external
hemorrhage) may lead to diffuse
(global) ischemia of the brain.
CNS INFECTIONS
2. Neuronal tumors
A. Ganglion Cell Tumors
B. Other Tumors with Glial and Neuronal
Components
C. Tumors with Only Neuronal Elements
Meningiomas
Astrocytoma
astrocytes astrocytoma, glioblastoma,
pilocytic astrocytoma, and pleomorphic
xanthoastrocytoma
about 80% of adult primary brain tumors
WHO astrocytoma (grade II/IV), anaplastic
astrocytoma (III/IV), and glioblastoma (IV/IV)
Pleomorphic
Xanthoastrocytoma
Oligodendroglioma
5% to 15% of gliomas and are most common in the
fourth and fifth decades
mostly in the cerebral hemispheres.
macroscopic are well-circumscribed, gelatinous, gray
masses, often with cysts, focal hemorrhage, and
calcification
microscopic cells with spherical nuclei containing
finely granular chromatin (similar to normal
oligodendrocytes) surrounded by a clear halo of
cytoplasm.
WHO grade II/IV lesions.
Anaplastic oligodendrogliomas (WHO grade III/IV)
are characterized by increased cell density, with nuclear
anaplasia, increased mitotic activity, and necrosis
Ependymoma
most often arise from ventricular system, including
the oft-obliterated central canal of the spinal cord.
5% to 10% of the primary brain tumors
In adults, the spinal cord is their most common location
microscopic cells with regular, round to oval nuclei
with abundant granular chromatin. Between the nuclei,
there is a variably dense fibrillary background. Tumor
cells may form gland-like round or elongated structures
(rosettes, canals)
GFAP expression is found in most ependymomas.
WHO grade II/IV lesions
anaplastic ependymomas occur with increased cell
density, high mitotic rates, areas of necrosis, and
less evident ependymal differentiation. These lesions
are more aggressive (WHO grade III/IV).
Ependymoma. A,
Tumor growing into
the fourth ventricle,
distorting,
compressing, and
infiltrating surrounding
structures. B,
Microscopic
appearance of
ependymoma.
3. POORLY DIFFERENTIATED
NEOPLASMS
Medulloblastoma
20% of the brain tumors in children are
located in the midline of the cerebellum
Dewasa lateral of the cerebellum
microscopic sheets of anaplastic cells.
Individual tumor cells are small, with little
cytoplasm and hyperchromatic nuclei
that are frequently elongated or crescent
shaped. Mitoses are abundant, and
markers of cellular proliferation, such as
Ki-67,
Medulloblastoma. A, CT scan showing a contrastenhancing midline lesion in the posterior fossa. B, Sagittal
section of brain showing medulloblastoma destroying the
superior midline cerebellum. C, Microscopic appearance of
medulloblastoma.
Atypical Teratoid/Rhabdoid
Tumor (AT/RT)
highly malignant tumor of young children
The histologic component of rhabdoid
cells, resembling those of a
rhabdomyosarcoma, is the defining
characteristic of the lesion.
Mitotic activity is extremely prominent.
found in the posterior fossa
These are highly aggressive tumors of the
very young, nearly all tumors occurring
before the age of 5 and most patients
living less than a year after diagnosis
4. MENINGIOMAS
Meningiomas are predominantly benign tumors of
adults, usually attached to the dura, that arise from
the meningothelial cell of the arachnoid
grade I/IV by the WHO classification
PAS-positive
Atypical meningiomas (WHO grade II/IV) are lesions
with a higher rate of recurrence and more aggressive
local growth that may require therapy in addition to
surgery. The diagnostic criteria a mitotic index of
four or more mitoses per 10 high power fields or three
or more of the atypical features
Certain histologic patterns (clear cell and chordoid) are
also considered to be grade II/IV because of their more
aggressive behavior
SELAMAT
BELAJAR