what virus is involved in PCNSL?
EBV
Diff of immunocomproised vs immunocompetent in PCNSL
Immunocompromised: young pxs, deep WM involvement ,multiple diff : toxoplasma
Immunocompetent : old age, periventricular, solitary diencephalic Diff dx : MS
Characterize HIV neuropathy
symmetrical pred sensory length dependent axonal
occurs usually when CD4 count is going down
sec to -direct effect of virus or upregulation of cytokines
AIDP in HIV- during the seroconversion period
Mononeuritis multiplex- usually not symmetrical, late in the course of dse and pxs have superimposed infection.
Potts disease charac of spine ?
Thoracic
hematogenous spread, usually starts at anterior region of vertebral body
back pain, spinal tenderness and spasm
variant of Hansen disease with extensive skin involvement ?
Lepromatous - occurs in impaired cell mediated immunity, spread on skin and cool areas of body ( tip of nose, pinna, dorsolat legs)
Tubercoluous- in good cell mediated , less skin involvement, but with thickened nerves , common ulnar, like mononeuritis multiplex
Dx- skin biopsy- inflamm granulomas with eptheloid and mononuclear infiltrates and AF organism
TXT : Rifampin, Dapsone, clofazimine
Diff : Nocardia - also AF organism but with respi symptoms, can cause cerebral abcess
Antibiotics for bact meningitis in >50y/o and immunocompromised pxs?
Vanco + 3rd gen + ampicillin
if neonate- cefotaxime + ampicillin ( listeria )
if neurosx- Vanco+ 3rg gen ceph ( ceftazidime ) + Ampicillin
if 3mos - onwards - 3rd gen ceph + vanco (+/-) ampicillin
MRSA- Vanco
Listeria- AMpicillin
Pseudo- ceftazidime, cefepime
Histo charac of primary CNS lymphoma
angiocentricity like mets but it has intact surrounding parenchyma
perineuronal satellitosis like GBM
Wet keratin
basaloid lining
stellate reticulum
Adamantinomatous craniopharingioma
Beta catennin mutation
Papillary craniophragioma
usually on 3rd Ventricle
No calcifications or keratin
gross app of craniopharyngioma
cystic and solid component
black sludge- aseptic meningitis/ xanthogranulomatous inflammation
sellar trumor
sellar tumor symptoms
Hypopituitarism
Growth retardation
Hyperprolactinemia- amenorrhaea and galactorrhea
Diabetes insipidus
visual sympyoms- bilateral temporal hemianopsia
3rd V- inc ICP
hypothalamus- behavioral , hypothermia, somnolence
TXT craniopharygioma
surgical- transphenoidal approach , if non resectable- stereotactic aspiration
steroid therapy before and after
temp control and water balance
snowman appearance on sellar region
Pituitary macroadenoma - >10mm size
snowman because of indentation on the diaphragmatic sella, usually growth is within sella rhen upwards- helps to diff vs. mengioma
Crooke’s hyaline change.
When anterior lobe corticotrophs are exposed to excess glucocorticoids, they undergo a reversible morphologic modification known as Crooke’s hyaline change.
- accumulation keratin in cytoplasm creating a pale glassy appearance
Basophils cells in adenohypophysis
Corticotrophs -pars intermedialis - ACTH
Thyrotrops- anteromedial aspect
Gonadotrops - pars tuberalis - LH, FSH
Acute hemorrhagic infarction of the pititary tumor
Pituitary apoplexy
Predisposing factors :
carotid angiography, radiation therapy, trauma, coagulopathy, temporal arteritis, diabetes mellitus and atherosclerosis.
The most common cause of Cushing’s disease is a
The most common cause of Cushing’s disease is a basophilic microadenoma.
genetic / chromosal location abnormalities of tumors:
Ependymoma and Meningioma
pineoblastoma
medulloblastoma
pituitary adenomas
optic glioma
ch 22, NF-2- Ependymoma and Meningioma
ch 11- pineoblastoma
ch 17- medulloblastoma
MEN-1- pituitary adenomas , mutation on MEN-1 gene on ch 11q13 that encodes tumor suppressor menin
NF-1 - optic glioma
usuall preferred location of tumors
Epidermoid
colloid
Arachnoid
Pilocytic and HBL
Dermoid
choroid
Epidermoid- CPA
colloid- 3rd v, formaen of monro
Arachnoid- temporal lobe
Pilocytic and HBL - cerebellum
Dermoid- cerebellar vermis
choroid - lateral ventricle
medulloblastoma- post fossa, roof of 4th V
ependymoma- floor of 4th V
DNET- juxtacortical
Oligodendroglioma- cortical-sybcortical
PCNSL - supratentorial- parenchyma- frontal>temporal>parietal>occipital
What is WHO recommendation for classi of atypical adenoma?
The WHO has recommended that invasive pituitary adenomas exhibiting increased mitotic activity, MIB-1 labelling index > 3% or extensive p53 expression be classified as ‘atypical adenomas’.
indicate the origin
adenohypophysis
neurohypophysis
chordoma
adenohypophysis- ectoderm , Rathke’s pouch
neurohypophysis- ectoderm
chordoma- notochord
ganglion cells that appear to float in mucin filled spaces
floating neurons in DNET
vacoulated cytoplasm , seperated by fibrous septa in chordoma
physaliphorous cells
Identify the purpose of IHC
GFAP
Melan A and HMB-45
CD45
CD3
CD20
Ki-67/ MIB -1
GFAP- glial filaments
Melan A and HMB-45- melanocytes
CD45- lymphocytes
CD3- T cells
CD20- B cells
Ki-67/ MIB -1- nuclear proliferation
