Path S.

OSPE 2004: (11 fail)

John, a 48 year old male presented with abdominal
distension and jaundice. The specimen displayed is a
slice of his liver and the photograph shows the
microscopic image of his liver biopsy.
Look at the specimen jar.
List two gross pathological features seen.
[1]
Look at the Photomicrograph liver biopsy.
Identify two microscopic features labeled A & B ? [1]
What clinical condition results from the process
demonstrated in the photomicrograph ()? Explain the
mechanism.
[2]
Mention two common etiological factors for this
condition in the pacific?
[1]

Area-A

Area-B

Path OSPE 2: (13 fail)

Alipate, a 61 year old male presented with pain
and difficulty during micturition gradually
increasing for the past 3 years.
Look at Pic1 his bladder with prostate.
What is the most probable clinical diagnosis?[]
List 4 features of the disease seen in the
picture? [2]
Look at picture 2 Prostate gland biopsy with two
areas marked A & B by a dotted line.
Which area is abnormal? List one microscopic
feature seen in this area?
[1]
Name the laboratory test done to diagnose
malignancy in this condition? What result you
would expect in this patient?
[1]

CNS Tumors

In every person who comes

near you look for what is good
and strong; honor that; try to
learn it, and your faults will
drop off like dead leaves when
their time comes.
--John Ruskin

Pathology of

CNS Tumors
Dr. Venkatesh M. Shashidhar, MD
Associate Professor of Pathology
Fiji School of Medicine
SUVA, Fiji Islands.
Fiji School of Medicine Commitment to Excellence

CNS Tumors

General Considerations
Limited space, filled by Delicate vital structure..

Normal brain is semifluid in consistency.!

Highly sensitive to hypoxia, Critical blood supply
Increased pressure destructive.
Location determines nature than the tumor
itself.

Common site of metastasis.

CNS Tumors

General Considerations
Comprise: 10% of all tumors

Most common childhood neoplasms

Peak incidence at 5th decade
Supratentorial tumors in adults
Infratentorial tumors in childhood
Primary tumors infiltrative

Metastasis well-demarcated
Intraneural spread, no extraneural spread

CNS Tumors

Simple Classification:
1. Primary Tumors:
Mainly from supporting glia, nerve
sheath, primitive cells, blood
vessel/bone.

2. Secondary Tumors - metastasis from

Ca breast, lung, GIT etc.* Commonest.
Mature Neurons do not give rise to neoplasms.
(Permanent cells)

CNS Tumors

Primary brain tumors.

Meninges: meningioma
Glia Astrocytes - astrocytoma
Oligodendrocytes - oligodendroglioma
Ependyma ependymoma, choroid plexus
papilloma, colloid cyst (Ventricles).

Primitive cells: blastoma e.g. neuroblastoma.

Neuronal * : ganglioglioma, gangliocytoma
Nerve sheath: schwannoma, neuroblastoma
Pituitary: adenoma, craniopharyngioma
Vascular & Bone tumors:

CNS Tumors

Clinical features:
Raised Intracranial Pressure.
Headache, vomiting, slow pulse,
papilloedema.

Local damage:
Nerve & tract deficits, Paralysis,
seizures etc.

CNS Tumors

Meningioma:

Arise from arachnoid granulations of

venous sinuses. Attached to dura.
Common sites: parasagittal (falx), sphenoid
ridge, olfactory groove
Females common (2:1)
Well demarcated Compression - No Invasion
Microscopic: whorls and psammoma bodies
Hyperostosis over the tumor.
Slow growth, well differentiated, no spread
(Benign).

Meningioma

CNS Tumors

Meningioma

CNS Tumors

Meningioma

CNS Tumors

Meningioma

CNS Tumors

Meningioma

CNS Tumors

Meningioma

Psammoma bodies

CNS Tumors

Glioma:

Gliomas are neoplasms of glial cells.

Astrocytoma Commonest benign
tumors with malignant behavior.
Ependymoma Rare, 4th ventricle.
Oligodendroglioma Benign, adults,
rare.

CNS Tumors

Astrocytoma

Astrocytoma Commonest tumors of

adults. (80%)
Well differentiated, slow growing.
Benign - but malignant behavior.
Infiltrative, poor demarcation
Glioblastoma Multiforme Malignant form of Astrocytoma.

CNS Tumors

Astrocytomas
Adults:
Supratentorial (Cerebrum),
Solid, Malignant, Fibrillary

Children:
Infratentorial (Cerebellum),
Cystic, Benign, Pilocytic

CNS Tumors

Fibrillary astrocytomas
Grossly solid
Common in cerebral hemispheres
Low grade in young, higher grade in
older
Grading
astrocytoma (low grade)
Anaplastic astocytoma
glioblastoma multiforme (high grade)

Astrocytoma - fibrillary

CNS Tumors

Fibrillary astrocytoma:
microscopic

Low grade- hypercellularity, pleomorphism

Anaplastic- as above plus mitosis, vascular
endothelial proliferation
Glioblastoma multiforme- as above plus
necrosis and pseudopalisades. Grossly
variegated appearance (multiforme)

Glioblastoma high grade Astrocytoma

Glioma Brain Stem

CNS Tumors

Glioma Cerebrum

Glioma:

Fibrillary Astrocytoma (Glioma)

Glioblastoma Multiforme

Glioblastoma Cerebrum

Glioma:

Glioma

Astrocytoma

Glioblastoma Multiforme

Glioblastoma Multiforme

CNS Tumors

Pilocytic astrocytoma

Common in childhood
Most slow growing of the gliomas
Sites: cerebellum, around III V., optic nerve
Grossly cystic with mural nodule
Microscopic
elongated hair-like (pilo) elongated cells
Rosenthal fibers

Pilocytic Astrocytoma - children

Pilocytic astrocytoma
Mural nodule

Formerly, when religion was

strong and science weak, men
mistook magic for medicine.

Now, when science is strong and

religion weak, men mistake
medicine for magic.

Other CNS tumors

CNS Tumors

Neuroectodermal Tumors

1.
2.
3.
4.

Origin from primitive blast cells.

Rosettes - attempted nerve formation.
Medulloblastoma Cerebellum
Retinoblastoma - Retina
Neuroblastoma Adrenal glands
Ganglioneuroma - Mediastinum

Medulloblastoma

Medulloblastoma

CNS Tumors

Nerve Sheath Tumors:

Neurofibroma:

Epi & endoneurial fibroblasts.

Form whorls of fibroblasts with nerves
Well differentiated, benign, capsulated.

Schwannoma:

Schwann cells, form whorls

Nuclear palisading

Schwannoma Cerebellum

Ependymoma Cerebellum

Ependymoma-hemorrhage

Ependymoma

CNS Tumors

Neurilemmoma

Schwannoma

Schwannoma

Schwannoma

It has been my
philosophy of life that
difficulties vanish
when faced boldly.
--Isaac Asimov