Pathology Associates Of Lexington, P.A.
Pathology Associates Of Lexington, P.A.
Pathology Associates Of Lexington, P.A.
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Neurological Anatomic Pathology
  • Medical disease:
    1. demyelinating disorders:
      • central: histiocytes are a marker, the Creutzfeldt cell (enlarged degenerating histiocytic cell with abnormal "starburst" mitosis) being an eyecatching enlarged & degenerating one (if seen on FS, be very cautious of diagnosing malignancy...a recent great example [T07-17] was in tissue surrounding a GBM).
      • cord & peripheral:
        1. transverse myelitis: a positive surgical biopsy shows foam cell (CD68+) and/or vacuolated neural change [LMC-03-2377]
    2. Alzheimer's:
  • Pseudotumor/neoplastic diseases:
    1. pseudotumors:
      • leptomeningeal or arachnoid cyst1: we would see as a specimen from "spinal stenosis" or "nerve entrapment" surgery [LMC-04-1850] or intracranial [LMC-05-6048]; it is a loculated accumulation of CSF & enclosed/organized by fibro-connective tissue and may be circumscribed by adhesions traversing the subarachnoid space.  Can lead to a punched out boney defect remindful radiographically of myeloma.  At spinal level most are said to be meningeal diverticulae that organize; extradural lesions in association with posterior spinal nerve roots are called "Tarlov's perineurial cyst".
      • pseudomeningocele, post-operative: If only an isolated extra-spinal pocket of CSF, it is non-communicating with the general CNS CSF space and seems just like a post-operative seroma. If it is openly "communicating", then patients tend to get headache when they assume an upright position. If only occassionaly communicating via a biological ball-valve mechanism, headaches may be scare & of brief duration. The trapped CSF has very low protein.
      • synovial (ganglion) cyst: arises from any axial site with synovium (facet, etc.).
      • simple gliotic cyst: no special lining & in middle-age to elderly adults
      • cystic lesion of multiple sclerosis (MS): very rare situation; basically a cystically degenerated demyelinating plaque [L07-11303...23 y/o F presented with facial paresis & found multiple cysts, the largest 2.8cm].
      • occult radiation necrosis: example...s/p radiation of SCC of scalp [L07-10762].
      • colloid cyst: usually antersuperior 3rd ventricle
      • Rathke pouch cyst: similar to colloid but contains squamous metaplasia
      • intraspinal cyst: from incomplete embryonic separation of endodermal and notochordal elements ("neurenteric cyst", "foregut cyst", "enterogenous cyst", "teratomatous cyst") and has an intradural location.
      • epidermoid cyst:
      • dermoid cyst:
      • glioependymal cyst: usually paraventricular & lined by mature-appearing ependymocytes.
    2. neoplasia:
    • benign:
      1. meningioma: likelihood of recurring increases if Ki67 greater than 5%, PR is negative, and tumor micro-insinuates in paravascular spaces into brain. But, oncologists & neurosurgeons unlikely to do anything until recurrence unless frankly malignant histfology [T07-18]2.
      2. solitary fibrous tumor (SFT): is CD34 stem cell marker positive; histology can be remindful of a Schwannoma or leiomyoma with A & B zones or crossing fasicles, respectively (can occur in any body cavity & even the orbit [L07-9025].
    • malignant: one should avail oneself of the features of the gross pathology (imaging) & temporal profile of clinical features of the case.
      1. metastatic lesions: choriocarcinomatous lesion [L07-10652] & pt. found to have a 520 gram testicular mass (nonseminomatous [L07-10864]).
      2. cystic:
        • cystic remnant of astrocytoma
      3. solid:
        1. glial:
          • gliosarcoma (Feigen tumor): pleomorphic spindled-cell malignancy (H&E remindful of MFH, spindled SCC, & melanoma), GFAP & vimentin pos. [L08-3199].
          • astrocytoma:
            • low grade (I/II): reactive and low grade can both have no mitoses & low ki67 on biopsy (as with reactive [L08-4289]) but malignant tends to have staggered rather than smooth gradations of nuclear size among neighbor atsrocytic cells and at least a small percentage with mildly hyperchromatic nuclei.
            • anaplastic astrocytoma (grade II of III or III of IV0.
            • glioblastoam multiforme (GBM): mitoses, necrosis, & vascular prliferation.
          • oligodendroglioma:

References:

  1. Rosai J, Ackerman's Surgical Pathology, 9th Ed.
  2. specialists at our tumor board.

(posted  8 April, 2003; latest addition 13 August 2008)
 
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