Neuropathology

Question 1

What is your Dx?

Answer 1

Epidural hematoma

Question 2

Which vessels are damaged to produce a subdural hematomas?

Answer 2

Bridging veins

Question 3

What is the germinal matrix? What is the clinical significance of it?

Answer 3

A region of cells involved in brain development; exist near the lateral ventricles. The region is vulnerable to hypoxia (which happens a lot with premature infants) and hemorrhage.

Question 4

Subarachnoid hemorrhages most commonly occur as a result of rupture of…?

What is a common clinical sign/symptom of subarachnoid hemorrhage?

Answer 4

Rupture of a berry aneurysm in the circle of Willis.

Sudden onset terrible headache (thunderclap headache) is a common symptom.

Question 5

What is the most common underlying cause of intracerebral hemorrhage?

Where in the brain do these most commonly occur?

Answer 5

Hypertension + arteriosclerosis –> vessel hemorrhage.

Most commonly occur in basal structures of the brain.

Question 6

Rank the cell types found in gray matter with respect to their vulnerabilities to hypoxia.

Answer 6

Neurons are most vulnerable

Oligodendrocytes

Astrocytes

Vessels

Question 7

Rank the cell types found in white matter with respect to their vulnerabilities to hypoxia.

Answer 7

Oligodentrocytes are most vulnerable

Astrocytes

Vessels

Question 8

Which two areas in the brain are particularly susceptible to hypoxia in both kids and adults?

Answer 8

CA1 aka Sommer’s sector of the hippocampus

Purkinje cells of the cerebellum

Question 9

Describe the histologic and cellular features of brain parenchyma after suffering from an infarct at 1 day post-infarct (acute phase), 1 day through 2 weeks post-infarct (subacute phase), and beyond 2 weeks post-infarct.

Answer 9

Acute: red neurons (necrotic neurons are highly eosinophilic)

1 day - 2 weeks: tons of neutrophils and macrophages

2+ weeks: astrogliosis (scar/cavitary lesion)

Question 10

You’re a pathologist and need to determine the time of death for some reason and you’re only given this histo slide. How long ago did this brain tissue suffer from ischemia?

Answer 10

1 day - 2 weeks ago

Question 11

You’re a pathologist and need to determine the time of death for some reason and you’re only given this histo slide. How long ago did this brain tissue suffer from ischemia?

Answer 11

1 day ago (or earlier)

Question 12

What are the risk factors for developing arteriole brain infarcts?

Answer 12

Hypertension, diabetes, old age

Question 13

In which region of the brain do lacunar infarcts most commonly happen?

Answer 13

In or near the basal ganglia

Question 14

Rickettsial infection may lead to regional brain infarcts involving ________ (type of vessel), leading to _______ hemorrhages.

Answer 14

capillaries –> petechial hemorrhages

Question 15

Regional brain infarcts involving veins often occur in patients who are _________.

What is the gross appearance of these?

Answer 15

hypercoagulable (cancer, dehydration, phlebitis)

Triangular shaped. If they involve the superior saggital sinus, there will be bilateral lesions in the cerebral hemispheres.

Question 16

What is cerebral amyloid angiopathy?

Answer 16

Idiopathic deposition of amyloid in small arteries and arterioles of the brain.

Question 17

Compare where primary CNS neoplasms occur within the brain for adults vs. kids.

Answer 17

Adults - supratentorial

Kids - infratentorial

Question 18

Name two infiltrative primary CNS neoplasms that occur in adults, and kids, respectively.

Answer 18

Adults: diffuse gliomas, primary CNS lymphomas

Kids: medulloblastomas, ependymomas

Question 19

Name the non-infiltrative primary CNS neoplasms that occur in adults, and kids, respectively.

Answer 19

Adutls: meningioma, schwannoma, metastatic disease -> brain

Kids: pilocytic astrocytoma, craniopharyngioma

Question 20

What are the most common presenting signs/symptoms of primary CNS neoplasms?

Answer 20

New onset of seizures, focal neurologic signs

Question 21

Astrocytomas and oligodendrogliomas are neoplasms of _____ cells.

Answer 21

glial

Question 22

GBM is a high grade neoplasm of ________ (cell type).

How do these appear grossly on imaging?

What are some histological characteristics of these?

Answer 22

neoplasm of astrocytes

CT: butterfly lesion (crosses midline)

Histology: pseudopalisading necrosis, vascular proliferation

Question 23

Your 81 year old senator patient presents with new onset seizures, so you cut their brain out to make the diagnosis histologically. What is your Dx?

Answer 23

GBM

Question 24

What is a predisposing factor for developing a primary CNS lymphoma? How is it treated?

Answer 24

Being immunocompromised is a predisposing factor (ex. HIV)

Steroids, chemo for Tx

Question 25

What kind of primary CNS neoplasm is seen here?

Answer 25

Primary CNS lymphoma

Question 26

Which hereditary cancer syndrome is associated with multiple meningiomas? What do these tumors characteristically have on CT imaging?

Answer 26

NF2 Dural tail

Question 27

Where do schwannomas/acoustic neuromas usually occur?

Answer 27

Vestibular branch of CN VIII

Question 28

Which hereditary cancer syndrome is associated with bilateral schwannomas?

Answer 28

NF2

Question 29

Describe three histopathologic characteristics of schwannomas.

Answer 29

Verocay bodies, Antoni A (densely cellular regions), Antoni B (less densely cellular regions)

Question 30

What is your Dx?

Answer 30

Metastasis to the brain (usually from a carcinoma). Could be a GBM, but look for them butterflies for those.

Question 31

What are the most common presenting signs/symptoms of primary CNS neoplasms in kids and why?

Answer 31

Ataxia and nausea/vomiting, cuz they occur near the cerebellum

Question 32

What type of primary CNS neoplasm are these found in?

Answer 32

Pilocytic astrocytoma

Question 33

What kind of tumor is this? Are these treatable via resection?

Answer 33

Pilocytic astrocytoma - yeah treatable with surgery

Question 34

Your patient presents with multiple neurofibromas and malignant peripheral nerve sheath tumors. You suspect a hereditary cancer syndrome, which encodes the _________ gene on chromosome \_\_\_\_\_.

Answer 34

NF1 is associated w/ neurofibromas and malignant peripheral nerve sheath tumors. NF1 gene on ch. 17 encodes the neurofibromin protein

Question 35

What gene, chromosome, and associated neoplasms are seen in patients with NF2 syndrome?

Answer 35

NF2 gene on ch. 22 encodes merlin/schwannomin It is also called MISME syndrome: **M**ultiple **I**nherited **S**chwannomas **M**eningiomas **E**pendymomas

Question 36

Is NF2 syndrome associated with neurofibromas?

Answer 36

No

Question 37

Name the genes and tumors associated with tuberous sclerosis.

Answer 37

TSC1 hamartin or TSC2 tuberin Cortical tubers Hamartomas Subependymal giant cell astrocytoma

Question 38

Name the genes, chromosome, and tumors associated with Von Hippel-Lindau disease.

Answer 38

VHL on chromosme 3 Cortical tubers Hemangioblastoma Renal cell carcinoma More