Infections. Meningitis- leptomenings (usually bakterial)
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1 Neuropathology
2 Neuropathology Cerebral Edema, raised intracranial pressure, Herniatio Malformations, Developmental Diseases Perinatal Brain Injury Trauma Cerebrovascular Diseases Infections Transmissible Spongiform Encephalopathies (Prion Diseases) Demyelinating Diseases Degenerative Diseases Genetic Metabolic Diseases Toxic and Acquired Metabolic Diseases Tumors
3 Infections Meningitis- leptomenings (usually bakterial) Meningoencephalitis Encephalitis- brain parenchyma (usually viral, aseptic) Brain abscess- focal (bacterial, fungal) Myelitis- spinal
4 Meningitis Bakterial pyogenic E.coli, B csop. Streptococcus Streptococcus pneumoniae, Listeria monocytogenes N. meningitidis H. influenzae Tuberculosis chronic Neurosyphilis (tercier), chronic Neuroborreliosis, chronic Viral aseptic enterovirus
5 Acute Pyogenic (Bacterial) Meningitis Different bacteria by different agegroups! Neonates, infants: Escherichia coli B Streptococcus Haemophilus influenzae Adolescents, young adults: Neisseria meningitidis Stretococcus pneumoniae Adults: Streptococcus pneumoniae Listeria monocytogenes
6 Fever Symptomes Increased intracranial pressure: Headace Neck stiffness (meningismus) Nasea / vomiting Clouding of consciousness Waterhouse- Friderichsen syndrome (bleeding of adrenal gland, petechia)- meningococcal sepsis
7 Complications Brain infarct Brain abscess Hydrocephalus internus Cerebral venous sinus thrombosis
8 Meningitis- Macroscopic Commonly on the convexity Thickening of the leptomeninges, nontransparent Pus in the subarachnoidal space Archive picture of SE-2nd Department of Pathology
9 Meningitis- histology Neutrophils in subarachnoideal space leptomeninges Neutrophil granulocytes= pus Brain parenchyma
10 Which microorganisms can cause this lesion? Mycobacterium tuberculosis (in miliary tuberculosis, hematogenous spread; granulomatosus infection) Haemophilus influenza (obligatory vaccination) Debajyoti Chatterjee et al: Vascular complications of tuberculous meningitis: An autopsy study (2015) Neurology India
11 CNS-Tumors No premalignant Lesion (no Dysplasia) Localisation!!! (symptomes, treatment) No extracranial metastastases Age No T Stadium WHO-Grade biologic behavior Histologic subtypes
12 What kinds of cells are located in Meningothelial cell CNS? Ependyma Astrocyta Oligodendroglia Plexus choroidea cells Microglia Neuron
13 CNS TUMORS I. GLIAL TUMORS ASTROCYTOMA OLIGODENDROGLIOMA EPENDYMOMA II. NEURONAL/GLIONEURONAL TUMORS III. PLEXUS CHOROIDEUS TUMORS IV. EMBRIONAL NEUROEPITHEL TUMORS medulloblastoma V. MENINGEALE TUMORS meningeoma VI. PRIMER CNS LYMPHOMAS VII. GERMCELL TUMORS VIII. METASTASES
14 WHO Grading Grade I. Grade IV. Because the common histological criteria of malignancy only partially useful Histological/cytological criteria: Nuclear atypia Cytological pleomorphism Mitotical activity Endothel proliferation Palisad, rosettes, papillary structures (and other similar psedostructures) and tumor localisation
15 Grade Prediction of biologic behavior Grade I. Grows slowly Bening Patients have long survival Curative treatment with operative resection Grade II. It grows relative slowly Infiltrative It can recurrance as a high grade tumor (transformation) Benign/malignant Grade III. Malignant Recurrance is commonly in a form as high grade tumor Proliferation, cellatypia Grade IV. High malignant agressive
16 MENINGOMA Usually benign (Grade I.) mesodermal tumor From arachnoidal cells Macroscopic: Usually on the brain convexity Compress the underlying brain Rounded mass Well-defined from the brain parenchyma Illustration: Robbins and Cotran s Pathological Basis of Pathology
17 Archive picture of SE-2nd Department of Pathology
18 Meningeoma- histology Various histologic patterns Usually has nested structure whorled pattern Spindel cells May contain psammoma bodies
19 Lokalisation/histological subtyp according different age Child Infratentorial (posterior fossa) Commonest solid cancer Medulloblastoma, high grade Pilocystic astrocytoma (grade I.) Adult Supratentorial Metastasis Gioblastoma Meningeoma
20 ASTROCYTOMA Grade I. Pilocytic astrocytoma Grade II. Diffuse astrocytoma Grade III. Anaplastic astrocytoma Grade IV. Glioblastoma (glioblastoma multiforme) Most common and malignant
21 Glioblastoma pathogenesis Primer glioblastoma: de novo (older)- commonly Secunder glioblastoma: from lowergrade astrocytoma (younger)
22 Glioblastoma- Macroscopic Necrosis Hemorrhage Diffuse infiltration, tumor borders undefined
23 It can involve both cerebral hemispheres by crossing the corpus callosum (butterfly tumor)
24 Glioblastoma- histology Solid, hypercellular tumor Polymorphic tumorcells Many mitosis Multinuclear giantcells Necrosis Pseudo-pallisading pattern around necrosis Endothelial or vascular cell proliferation
25 BRAIN METASTASIS More common than primer intracranial malignant tumors! Commonly multiple, hemispheres-peripherial zone LUNGS BREAST MELANOMA KIDNEY GASTROINTESTINAL Primar brain tumors don t have extracranial metastases! (except: CSF, medulloblastoma)
26 Brain metastasis- Macroscopic Sharpy demarketed Soliter/ multifocal Archive picture of SE-2nd Department of Pathology
27 Brain metastasis- histology Brain tissue tumor Sharp border
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