CNS pathology Third year medical students · 2018-08-11 · CNS lymphoma • Aggressive disease...
Transcript of CNS pathology Third year medical students · 2018-08-11 · CNS lymphoma • Aggressive disease...
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CNSpathologyThirdyearmedicalstudents
DrHeyamAwad2018
Lecture13:CNStumours3/3
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meningioma
•Arisefromarachnoidmeningothelialcells.•Ariseinadults•Attachedtothedura•Canbeseenatexternalsurfacesofthebrainorwithintheventricularsystem
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meningioma
•Majority:canbeeasilyseparatedfrombrain,butsomeareinfiltrative•Behaviour:benignbutinfiltrativelesionsrecur•Outcomedependson:size,location,histologicalgrade
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Histologicalgrades
•WHOI:(welldiff)meningioma•WHOII:atypicalmeningioma•WHOIII:anaplastic(malignant)meningioma
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Grade1meningiomas
•Welldefined,durabasedmasses•Maycompressbutdonotinvadebrain•Canextendtooverlyingbone
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• Grade1meningiomas/histologicaltypes• •Syncytial:whorledclusterswithoutvisiblecellmembranes.• •Fibroblastic:elongatedcellsandabundantcollagen• •Transitional:featuresofboth,syncytialandfibroblastic• •Psammomatous:numerouspsammomabodies
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syncitial
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fibroblastic
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pasammomatous
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AtypicalmeningiomaWHOgrade2
•Highcellularity•Prominentnuclei•Highmitoticrate•Moreaggressivethangrade1•Recur
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Atypicalmeningioma
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Anaplasticmeningioma
• AnaplasticmeningiomaWHOgrade3•Highlyaggressive•Resemblesarcomas
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PrimaryCNSlymphoma
• Mostly:diffuselargeBcelllymphoma.•1%ofintracranialtumors.•PrimaryCNSlymphomaisthemostcommonCNSneoplasmintheimmunocompromised…inthissituationtheyarealmostalwayspositiveforEBV((Epstein– Barrvirus)
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CNSlymphoma
• Aggressivediseasewithpoorprognosis•Poorresponsetochemotherapyascomparedtoperipherallymphomas•Usuallymultiplenoduleswithinthebrainparenchyma•Spreadingoutsidethebrainhappensrarelyandatlatestages•Peripherallymphomararelyspreadstothebrain,ifitdoesthereisusuallyassociatedmeningealandCNSinvolvement.
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lymphoma
• Involvesdeepgreymatter,whitematter,cortex•Periventricularspreadiscommon•Tumornodulesmoredefinedthangliomasbutlessthanmetastases•EBVpositivetumorsusuallyhaveextensiveareasofnecrosis•Majority:diffuselargeBcelllymphomas
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lymphoma:notethemultiplicityofthelesions
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lymphoma
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Metastatictumors
- ¼to½ofintracranialtumors•Mostcommonprimarysites:lung,breast,melanoma,kidneyandGIT.•Formdiscretewelldefinedmasses,canbemultiple
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Paraneoplasticsyndromes
•CNSandperipheralnervescanbeaffectedindisseminatedcanceraspartoftheparaneoplasticsyndromes•Theseincludeseveralmanifestationsincludingdementia,ataxia,sensoryneuropathyandpsychosis
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Familialtumorsyndromes
•Inheritedsyndromes•Mutationsinseveraltumorsuppressorgenes•Associatedwithincreasedriskofcertaintypesofcancer•2syndromeswithCNSinvolvement:TuberoussclerosisandvonHippel- Lindou
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•Tuberoussclerosis
• Autosomaldominant• Hamartmasandbenignneoplasmsinbrainandothersites• CNStumors:corticaltubersandsubependymalhamartomas
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• Tuberoussclerosis
•Corticaltubers:looklikepotatoes!!•Tuber:thickenedundergroundpartofastem
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• Corticaltubers:Hamartomascomposedofhaphazardlyarrangedlargeneurones.• Mixtureofglialandneuronalcells• Causeseizures
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Tuberoussclerosis..potatoesinthebrain!
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• Subependymaltubers:Similartocorticaltubers• Cancausehydrocephalus
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• Tuberoussclerosis/Extracerebrallesions
• renalangiomyolipoma,• retinalglialhamartomas,• pulmonarylymphangiomatosis• cardiacrhabdomyoma• cystsinliver,kidney,pancreas.• skinlesions:angiofibroma,hypopigmentedareas,thichenedpatches.
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•VonHippelLindausyndrome
• Autosomaldominant• MutationinVHLtumorsupressorgene.• Hemangioblastomasmainlyincerebellarhemispheres,retina.• Cystsinpancreas,liverkidney• Increaseriskofrenalcellcarcinoma
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