Intra-Operative Neuropathology for the Non-Neuropathologist (eBook)

Intra-Operative Neuropathology for the Non-Neuropathologist 3
Preface 5
Contents 7
Contributors 9
1: The Role of Clinical-Pathologic Correlation and Use of Cytologic Preparations in Intraoperative Neuropathology Consultation 11
Summary Points (Steps to Achieve the Best Answer Possible for the Patient) 22
General References 22
Journal Articles 22
Books 22
2: Neuroradiology as a Tool in Neuropathologic Diagnosis of Intracranial Masses 23
Introduction 23
Basics of CT and MRI 23
CT Terminology 23
MRI Terminology 23
Distinguishing Imaging Features 25
Edema 26
Shape 28
Density/Signal Intensity 28
Flow-Voids 28
Enhancement Patterns 30
Diffusion 30
Perfusion 31
Intra-axial Supratentorial Masses 32
Low-Grade Astrocytoma (Fig. 2.23) 32
Oligodendroglioma (Fig. 2.24) 32
High-Grade Glioma/Gbm (Figs. 2.8 , 2.25 , and 2.26) 33
Ganglioglioma (Fig. 2.27) 33
DNET (Fig. 2.28) 33
Central Neurocytoma (Fig. 2.29) 33
PCNSBCL (Figs. 2.10 , 2.18 , and 2.30) 33
Metastasis (Figs. 2.2 , 2.11 , 2.12 , and 2.31) 35
Abscess (Figs. 2.6 , 2.15 , 2.21 , and 2.32) 35
Infarct (Figs. 2.7 and 2.13) 35
Tumefactive Demyelinating Lesion (Figs. 2.9 , 2.17 , and 2.33) 36
PML (Fig. 2.34) 36
Intra-axial Infratentorial Masses 36
PA (Figs. 2.20 and 2.35) 36
Medulloblastoma (Figs. 2.19 and 2.36) 38
Ependymoma (Fig. 2.37) 38
Hemangioblastoma (Fig. 2.38) 38
Subependymoma (Fig. 2.39) 38
Metastasis (Figs. 2.11 and 2.31) 39
Extra-axial Supra/Infratentorial Masses 39
Meningioma (Figs. 2.5 and 2.40) 39
Systemic Lymphoma (Fig. 2.41) 40
Extra-axial Metastasis (Fig. 2.42) 40
Choroid Plexus Papilloma (Fig. 2.43) 40
Schwannoma (Fig. 2.44) 40
Extra-axial Sella /Skull Base/ Pineal Masses 40
Pituitary Adenoma (Fig. 2.45) 40
Parasellar Meningioma (Fig. 2.46) 42
Cavernous Sinus Hemangioma (Fig. 2.47) 42
Parasellar Schwannoma (Fig. 2.48) 43
Craniopharyngioma (Fig. 2.49) 43
Plasmacytoma/Multiple Myeloma (Fig. 2.50) 44
Chordoma (Fig. 2.51) 44
Chondrosarcoma (Fig. 2.52) 44
Olfactory Neuroblastoma (Fig. 2.53) 44
Pineoblastoma (Fig. 2.54) 44
Germ Cell Tumor (Fig. 2.55) 47
Spinal Masses 47
Schwannoma (Fig. 2.56) 47
Myxopapillary Ependymoma (Fig. 2.57) 49
Meningioma (Fig. 2.58) 49
Ependymoma (Fig. 2.59) 49
Astrocytoma (Fig. 2.60) 49
Hemangioblastoma (Fig. 2.61) 49
References 50
3: The Supratentorial Mass in an Adult 51
Case 3A A 36-Year-Old Male with an Incidental Frontal Lesion 51
Clinical History 51
What Is Your Diagnosis? 53
Figure Discussion 54
Scans 54
Pathology 54
Diagnosis: Low-Grade Astrocytoma 54
Differential Diagnosis: Gliosis 54
Differential Diagnosis: Oligodendroglioma 55
Differential Diagnosis: Other Primary Low-Grade Glial Tumor 56
Differential Diagnosis: PCNSL 57
Case 3B A 40-Year-Old Female with New Onset Seizures 59
Clinical History 59
What Is Your Diagnosis? 61
Figure Discussion 62
Scans 62
Pathology 62
Diagnosis: Oligodendroglioma 62
Differential Diagnosis: Gliosis (Astrocytosis) 63
Differential Diagnosis: Normal White Matter 63
Differential Diagnosis: Low-Grade Diffuse Astrocytoma 64
Differential Diagnosis: Extraventricular Neurocytoma 64
Differential Diagnosis: DNET 65
Differential Diagnosis: PCNSL 65
Differential Diagnosis: Pilocytic 65
Differential Diagnosis: Ependymoma (Especially Clear Cell) 66
Differential Diagnosis: Small Cell Anaplastic 66
Differential Diagnosis: Glioblastoma 67
Cautions 67
Case 3C A 74-Year-Old Female with Seizure, and Hemiparesis 68
Clinical History 68
What Is Your Diagnosis? 70
Figure Discussion 71
Scans 71
Pathology 71
Diagnosis: High-Grade Glioma 71
Differential Diagnosis: Abscess 72
Differential Diagnosis: High-Grade Oligodendroglioma 72
Differential Diagnosis: Other Primary Lesions 73
Differential Diagnosis: Metastasis 73
Differential Diagnosis: Infarct 74
Cautions 75
Case 3D A 50-Year-Old Male with Seizure and Unilateral Weakness 76
Clinical History 76
What Is Your Diagnosis? 77
Figure Discussion 78
Scans 78
Pathology 78
Diagnosis: Metastatic Tumor 78
Differential Diagnosis: Lymphoma 78
Differential Diagnosis: High-Grade Glioma 79
Differential Diagnosis: Malignant Dural Tumors 79
Differential Diagnosis: Primary Bone Tumors Versus Base of Skull Mets 80
Cautions 80
Case 3E A 70-Year-Old Male with Dense Hemiparesis and History of Kidney Transplant 81
Clinical History 81
What Is Your Diagnosis? 82
Figure Discussion 83
Scans 83
Pathology 83
Diagnosis: Infarct 83
Differential Diagnosis: Glioblastoma 84
Differential Diagnosis: PML 84
Differential Diagnosis: MS 84
Differential Diagnosis: Abscess 84
Cautions 85
Case 3F A 74-Year-Old Female with Headache, Confusion and Personality Change 86
Clinical History 86
What Is Your Diagnosis? 87
Figure Discussion 88
Scans 88
Pathology 88
Diagnosis: Primary CNS B-Cell Lymphoma 88
Differential Diagnosis: Metastases (Particularly Melanoma) 88
Differential Diagnosis: Glioma 88
Differential Diagnosis: Non-neoplastic Lymphoid Proliferations 89
Cautions 89
Case 3G A 65-Year-Old Male with Dizziness and Left Arm/Leg Weakness 90
Clinical History 90
What Is Your Diagnosis? 91
Figure Discussion 92
Scans 92
Pathology 92
Diagnosis: Gliosarcoma 92
Differential Diagnosis: Primary or Metastatic Sarcoma 92
Case 3H A 39-Year-Old Male with New-Onset Seizures 94
Clinical History 94
What Is Your Diagnosis? 95
Figure Discussion 96
Scans 96
Pathology 96
Diagnosis: Ganglioglioma 96
Differential Diagnosis: Normal Cortex, Deep Gray Matter, Amygdala 96
Differential Diagnosis: Neurons Trapped in Tumor 96
Differential Diagnosis: DNET 97
Differential Diagnosis: SEGA 97
Cautions 98
Case 3I A 25-Year-Old Female with Headache, Nausea , Blurry Vision 99
Clinical History 99
What Is Your Diagnosis? 100
Figure Discussion 101
Scans 101
Pathology 101
Diagnosis: Neurocytoma 101
Differential Diagnosis: Oligodendroglioma 101
Differential Diagnosis: Ependymoma 102
Differential Diagnosis: Metastatic Small Cell Carcinoma 102
Differential Diagnosis: Subependymoma 102
Cautions 103
Case 3J A 21-Month-Old Male with Developmental Regression 104
Clinical History 104
What Is Your Diagnosis? 105
Figure Discussion 106
Scans 106
Pathology 106
Diagnosis: Choroid Plexus Papilloma 106
Differential Diagnosis: Papillary Ependymoma 106
Differential Diagnosis: ELST 106
Differential Diagnosis: Papillary Craniopharyngioma 107
Differential Diagnosis: Papillary Metastatic Tumor 107
Differential Diagnosis: Papillary Meningioma 107
Cautions 108
Bibliography 58
Low-Grade Astrocytoma 58
Bibliography Oligodendroglioma 67
Bibliography High-Grade Glioma 75
Bibliography Metastatic Tumor 80
Bibliography Infarct 85
Bibliography Primary CNS B-Cell Lymphoma 89
Bibliography Gliosarcoma 93
Bibliography Ganglioglioma 98
Bibliography Neurocytoma 103
Bibliography Papilloma 108
4: The Infratentorial Intra-axial Tumor 109
Case 4A A 15-Year-Old Female with Headache, Nausea, and Vomiting 109
Clinical History 109
What Is Your Diagnosis? 111
Figure Discussion 112
Scans 112
Pathology 112
Diagnosis: Pilocytic Astrocytoma 112
Differential Diagnosis: Piloid Gliosis 112
Differential Diagnosis: Vascular Malformation 113
Differential Diagnosis: Fibrillary Astrocytoma 113
Differential Diagnosis: Ependymoma 113
Differential Diagnosis: Medulloblastoma 114
Cautions 114
Case 4B A 12-Year-Old Male with Headache, Irritability, and Vertigo 115
Clinical History 115
What Is Your Diagnosis? 116
Figure Discussion 117
Scans 117
Pathology 117
Diagnosis: Medulloblastoma 117
Differential Diagnosis: Normal Cerebellum 117
Differential Diagnosis: Ependymoma 118
Differential Diagnosis: Pineoblastoma 118
Differential Diagnosis: PNET 119
Differential Diagnosis: Atypical Teratoid/Rhabdoid Tumor 119
Differential Diagnosis: Other Small Round Blue Cell Tumors 119
Cautions 119
Case 4C A 12-Year-Old Female with Headache, Nausea/Vomiting, and Vertigo 121
Clinical History 121
What Is Your Diagnosis? 122
Figure Discussion 123
Scans 123
Pathology 123
Diagnosis: Ependymoma 123
Differential Diagnosis: Medulloblastoma 123
Differential Diagnosis: Subependymoma 124
Differential Diagnosis: Glioma 124
Differential Diagnosis: Neurocytoma 125
Differential Diagnosis: Choroid Plexus Papilloma 125
Cautions 125
Case 4D A 60-Year-Old Male with Headache and Ataxia 126
Clinical History 126
What Is Your Diagnosis? 127
Figure Discussion 128
Scans 128
Pathology 128
Diagnosis: Hemangioblastoma 128
Differential Diagnosis: Normal Cerebellum 128
Differential Diagnosis: Metastatic Clear Cell Carcinoma 128
Differential Diagnosis: Meningioma 128
Differential Diagnosis: Pilocytic Astrocytoma 129
Differential Diagnosis: Vascular Malformation 129
Cautions 130
Case 4E A 30-Year-Old Female with Headaches and Visual Changes 131
Clinical History 131
What Is Your Diagnosis? 132
Figure Discussion 133
Scans 133
Pathology 133
Diagnosis: Meningioma 133
Differential Diagnosis: Schwannoma 134
Differential Diagnosis: Hemangiopericytoma 134
Differential Diagnosis: Gliosarcoma 135
Cautions 135
Bibliography 114
Pilocytic Astrocytoma 114
Bibliography Medulloblastoma 120
Bibliography Ependymoma 125
Bibliography Hemangioblastoma 130
Bibliography Meningioma 135
5: The Base of Skull (Including Pineal and Sella Turcica Regions) Lesion 136
Case 5A A 27-Year-Old Female with Visual Disturbance and Headaches 136
Clinical History 136
What Is Your Diagnosis? 137
Figure Discussion 138
Scans 138
Pathology 138
Diagnosis: Pituitary Adenoma 138
Differential Diagnosis: Normal Anterior Pituitary 138
Differential Diagnosis: Meningioma 138
Differential Diagnosis: Plasma Cell Dyscrasia 139
Differential Diagnosis: Germ Cell Tumors 139
Differential Diagnosis:– Metastatic Tumor 139
Differential Diagnosis: Pituicytoma 139
Cautions 140
Case 5B A 56-Year-Old Female with Headache, Dizziness, Double Vision 141
Clinical History 141
What Is Your Diagnosis? 142
Figure Discussion 143
Scans 143
Pathology 143
Diagnosis: Plasmacytoma 143
Differential Diagnosis: Pituitary Adenoma 143
Differential Diagnosis: Meningioma 143
Differential Diagnosis: Metastases 143
Differential Diagnosis: Germ Cell Tumors 143
Differential Diagnosis: Other 144
Cautions 144
Case 5C A 55-Year-Old Male with Complaints of Swallowing Difficulties 145
Clinical History 145
What Is Your Diagnosis? 146
Figure Discussion 147
Scans 147
Pathology 147
Diagnosis: Chordoma 147
Differential Diagnosis: Chondrosarcoma 147
Differential Diagnosis: Myxopapillary Ependymoma 147
Differential Diagnosis: Metastatic Carcinoma 147
Differential Diagnosis: Chordoid Meningioma 148
Cautions 148
Case 5D A 23-Year-Old Female with Nasal Congestion and Forehead Pain 149
Clinical History 149
What Is Your Diagnosis? 150
Figure Discussion 151
Scans 151
Pathology 151
Diagnosis: Olfactory Neuroblastoma 151
Differential Diagnosis: Plasma Cell Dyscrasia 151
Differential Diagnosis Pituitary Adenoma 151
Differential Diagnosis: Invasion from the Paranasal Sinuses/Nasopharynx 151
Cautions 152
Case 5E An 18-Year-Old Female with Headache 153
Clinical History 153
What Is Your Diagnosis? 154
Figure Discussion 155
Scans 155
Pathology 155
Diagnosis: Pineoblastoma 155
Differential Diagnosis: Normal Pineal/Pineal Cyst 155
Differential Diagnosis: Medulloblastoma 155
Differential Diagnosis: Other Metastatic/Primary Small Round Blue Cell Tumors 156
Differential Diagnosis: Germ Cell Neoplasm 156
Cautions 156
Case 5F A 11-Year-Old Male with Headache, Nausea, Vomiting 157
Clinical History 157
What Is Your Diagnosis? 158
Figure Discussion 159
Scans 159
Pathology 159
Diagnosis: Germ Cell Tumor 159
Differential Diagnosis: Pineoblastoma/Medulloblastoma 159
Differential Diagnosis: Pituitary 159
Differential Diagnosis: Metastatic Tumors 159
Differential Diagnosis: Ependymoma 160
Cautions 161
Bibliography 140
Pituitary Adenoma 140
BibliographyPlasmacytoma 144
Bibliography Chordoma 148
Bibliography Olfactory Neuroblastoma 152
Bibliography Pineoblastoma 156
Bibliography Germ Cell Tumor 161
6: The Spinal Neoplasm in an Adult 162
Case 6A: A 44-Year-Old Male with Leg and Back Pain 162
Clinical History 162
What Is Your Diagnosis? 163
Figure Discussion 164
Scans 164
Pathology 164
Diagnosis: Myxopapillary Ependymoma 164
Differential Diagnosis: Chordoma 164
Differential Diagnosis: Peripheral Nerve Sheath Tumor 164
Differential Diagnosis: Papillary/Mucinous Metastatic Neoplasms 165
Cautions 165
Case 6B: A 36-Year-Old Male with Leg Weakness and History of Neurofibromatosis 1 (NF1) 166
Clinical History 166
What Is Your Diagnosis? 167
Figure Discussion 168
Scans 168
Pathology 168
Diagnosis: Schwannoma 168
Differential Diagnosis: Neurofibroma 168
Differential Diagnosis: Meningioma 168
Differential Diagnosis: Myxopapillary Ependymoma 168
Differential Diagnosis: Pilocytic Astrocytoma 169
Differential Diagnosis: Ganglioneuroma/Blastoma 170
Differential Diagnosis: Malignant Spindle Cell Tumors (Primary or Metastatic) 170
Cautions 170
References 171
ReferencesMyxopapillary Ependymoma 165
Schwannoma 171
Index 172