soal gambar 4 Flashcards
What is the most likely diagnosis?
A. Toxoplasmosis
B. Alzheimer’s disease
C. Neurocysticercosis
D. Ecliinococcus
E. Spinal cord injury
B. Note the prominent diffuse plaques traversed by
neuronal processes in this patient with Alzheimer’s disease.
Diffuse amyloid plaques are extracellular, ill-defined focal
aggregates of amyloid and preamyloid material and are
approximately 60 to 300 mm in diameter. Neuronal cell
processes traversing the plaque typically appear normal
and do not contain tau protein (Ellison, pp. 553-557).
What is depicted in the photomicrograph below
A. Choroid plexus papilloma
B. Ependymoma
C. Adamantinomatous craniopharyngioma
D. Chordoma
E. Angiomatous meningioma
C. Note the squamous cells, peripheral palisading of
nuclei, and nodules of wet keratin in this adamantinomatous
craniopharyngioma (Ellison, pp. 724-727; WHO, pp. 244-
246).
A wedding singer from your town presents to your office
with a 1-week history of neck pain and slight left arm and
hand numbness. His MRI is depicted below (Figure 8.168-
8.169Q). What is the most likely diagnosis?
A. Synovia l cyst
B. Juxtaface t cys t
C. Hypertrophy of the ligamentum flavum
D. Disc herniation
E. Ossification of the posterior longitudinal ligament
(OPLL)
D; Depicted here is an axial and parasagittal MRI
showing a soft (mainly disc material) posterolateral disc
herniation of the cervical spine that is eccentric to the left.
Considering that this disc herniation is not purely central, it
may be amenable to a posterolateral procedure in an attempt
to preserve vocal cord function (posterior keyhole lami-
notomy) in this wedding singer. Over 90% of patients with
acute cervical radiculopathy will improve with nonsurgical
c
therapy including adequate pain medication and anti-
inflammatories. Surgery is indicated for those who fail to
improve or develop progressive neurologic deficits while
undergoing nonsurgical therapy. A number of large series
have reported good or excellent results in 90 to 96% of
patients who underwent a posterior approach for such disc
herniations (Greenberg, pp. 310-314).
The patient’s symptomatology does not improve after
8 weeks of nonsurgical therapy. He returns to your office
to explore surgical options. You inform him that the best
surgical option for him should include what procedure, if
possible?
A. Anterior cervical discectomy and fusion
B. Posterior cervical laminectomy
C. Posterior keyhole laminotomy
D. Anterior cervical corpectomy and fusion
E. Costotransversectomy
C. Depicted here is an axial and parasagittal MRI
showing a soft (mainly disc material) posterolateral disc
herniation of the cervical spine that is eccentric to the left.
Considering that this disc herniation is not purely central, it
may be amenable to a posterolateral procedure in an attempt
to preserve vocal cord function (posterior keyhole lami-
notomy) in this wedding singer. Over 90% of patients with
acute cervical radiculopathy will improve with nonsurgical
c
therapy including adequate pain medication and anti-
inflammatories. Surgery is indicated for those who fail to
improve or develop progressive neurologic deficits while
undergoing nonsurgical therapy. A number of large series
have reported good or excellent results in 90 to 96% of
patients who underwent a posterior approach for such disc
herniations (Greenberg, pp. 310-314).
What is depicted in Figure
A. Pleomorphic xanthoactrocytoma
B. Ependymoma
C. Choriocarcinoma
D. Medulloblastoma
E. Adenohypophysis
E. Note the prominent lobules of cells with an interven-
ing vascular network of sinusoids in this photomicrograph of
a normal adenohypophysis (Ellison, p. 716).
A 54-year-old male presents to the emergency depart-
ment with a generalized tonic-clonic seizure and a 6-month
history of behavioral changes. His lateral angiogram is
depicted below. What is the most
likely diagnosis?
A. Hydrocephalus from a third ventricular tumor
obstructing the foramen of Monro
B. Glioblastoma
C. Olfactory groove meningioma
D. Craniopharyngioma
E. Arterial-venous malformation
C. Note that the anterior cerebral arteries are
being pushed upward on this lateral angiogram, depicting
an olfactory groove meningioma. These lesions often grow
insidiously, causing gradual compression of the frontal lobes;
thus they are quite large and bilateral by the time of presen-
tation. Common signs/symptoms may include headaches,
personality changes, visual loss, anosmia, and seizures. A
bifrontal transbasal approach is frequently used in resecting
these tumors, although a unilateral subfrontal or frontotem-
poral (pterional) craniotomy can also be used. The anterior
and posterior ethmoid arteries typically supply olfactory
groove meningiomas (Kaye and Black, pp. 523-532 ;
Youmans, pp. 1115-1115) .
The most common blood supply to this lesion originates
from what blood vessel(s)?
A. Superior hypophyseal artery
B. Anterior meningeal branches from the maxillary
artery
C. Superficial temporal artery
D. Anterior meningeal branches from the cavernous
internal carotid artery
E. The anterior and posterior ethmoidal arteries
E. Note that the anterior cerebral arteries are
being pushed upward on this lateral angiogram, depicting
an olfactory groove meningioma. These lesions often grow
insidiously, causing gradual compression of the frontal lobes;
thus they are quite large and bilateral by the time of presen-
tation. Common signs/symptoms may include headaches,
personality changes, visual loss, anosmia, and seizures. A
bifrontal transbasal approach is frequently used in resecting
these tumors, although a unilateral subfrontal or frontotem-
poral (pterional) craniotomy can also be used. The anterior
and posterior ethmoid arteries typically supply olfactory
groove meningiomas (Kaye and Black, pp. 523-532 ;
Youmans, pp. 1115-1115) .
What is the diagnosis of the lesion depicted in this
photomicrograph
A. Dysembryoplastic neuroepithelial tumor (DNT)
B. Central neurocytoma
C. Pleomorphic xanthoastrocytoma (PXA)
D. Giant cell astrocytoma (GCA)
E. Chordoid glioma of the third ventricle
A. This lesion is most consistent with a DNT
(WHO grade I). Patients usually present with long-standing
drug-resistant partial seizures that begin before the age of 20.
They are usually found in the temporal lobe or other supra-
tentorial location and typically encompass the cerebral
cortex. On occasion, they appear to deform the overlying cal-
varium, a finding that further supports the diagnosis of DNT.
The histologic hallmark of this tumor is the glioneuronal
element, which is shown here to consist of a free-floating
neuron in a microcyst surrounded by oligodendroglial-like
cells (Ellison, pp. 659-661 ; WHO, pp. 103-106) .
What is the histologic hallmark of this lesion?
A. Rosenthal fibers
B. Alzheimer II astrocytes
C. Glioneuronal element
D. Synaptophysin reactivity
E. Bizarre-appearing nucleated cells
C. This lesion is most consistent with a DNT
(WHO grade I). Patients usually present with long-standing
drug-resistant partial seizures that begin before the age of 20.
They are usually found in the temporal lobe or other supra-
tentorial location and typically encompass the cerebral
cortex. On occasion, they appear to deform the overlying cal-
varium, a finding that further supports the diagnosis of DNT.
The histologic hallmark of this tumor is the glioneuronal
element, which is shown here to consist of a free-floating
neuron in a microcyst surrounded by oligodendroglial-like
cells (Ellison, pp. 659-661 ; WHO, pp. 103-106) .
Patients harboring this lesion typically present with
A. Meningitis
B. Seizures
C. Hemorrhage
D. Leptomeningeal dissemination
E. Hydrocephalus
B. This lesion is most consistent with a DNT
(WHO grade I). Patients usually present with long-standing
drug-resistant partial seizures that begin before the age of 20.
They are usually found in the temporal lobe or other supra-
tentorial location and typically encompass the cerebral
cortex. On occasion, they appear to deform the overlying cal-
varium, a finding that further supports the diagnosis of DNT.
The histologic hallmark of this tumor is the glioneuronal
element, which is shown here to consist of a free-floating
neuron in a microcyst surrounded by oligodendroglial-like
cells (Ellison, pp. 659-661 ; WHO, pp. 103-106) .
. A 77-year-old male presents to your office with a
4-month history of unilateral epistaxis and nasal discharge.
His MRI is depicted below (Figure 8.2640J. Histopathologic
analysis of the tumor revealed uniform small cells with round
nuclei, scant cytoplasm, a prominent reticular core, and
scattered Homer-Wright rosettes. Immunohistochemistry
was positive for neuron-specific enolase and S-100 but was
cytokeratin, GD20, and CD79a negative. What is the most
likely diagnosis?
A. Lymphoma
B. Squamous cell carcinoma
C. Esthesioneuroblastoma
D. Adenocarcinoma
E. Rhabdomyosarcoma
C. The clinical history of this patient and destructive
MPd appearance of this lesion are highly suggestive of a
malignant neoplasm involving the paranasal sinuses. The
histologic and immunohistochemical markers are most
consistent with esthesioneuroblastoma (Kaye and Laws,
pp. 885-889) .
The photomicrograph depicted below
is most consistent with what diagnosis?
A. Tuberculosis
B. Chronic infarct
C. Multiple sclerosis
D. Histoplasmosis
E. Pilocytic astrocytoma
. A. Within this tuberculoma, note the prominent region
of caseating necrosis (left), in which no cellular detail can be
ascertained. A peripheral rim of lymphocytes and a fibrous
capsule surround the granuloma, and an occasional histio-
cyte is observed (Ellison, pp. 339-342) .
The gross specimen depicted below (Figure 8.279Q)
reveals?
A. Neurocysticercosis
B. Third ventricular tumor
C. Metastatic disease
D. Toxoplasmosis
E. Multiple sclerosis
C. Note the multiple lesions at the gray-white junction,
which is most consistent with metastatic disease (Ellison,
pp. 743-750) .
What is depicted on the CT scan below
A. Evidence of posterior interhemispheric blood after
head trauma
B. Empty delta sign of superior sagittal thrombosis associ-
ated with a cystic tumor
C. Pineocytoma
D. A hyperdense MCA sign
E. A left posterior temporal infarct
B. Note the empty delta sign, representing an occluded
superior sagittal sinus. This abnormality may be associated
with pregnancy, dehydration, infections, hypercoagulable
states, and tumors (as in this case) (Merritt, pp. 269 -
271) .
