Brain/meningeal tumor: Difference between revisions

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Measure the size of the specimen in 3 dimensions.  
Measure the size of the specimen in 3 dimensions.  
[[File:Histopathology of meningioma.png|thumb|Histopathology of a typical WHO grade 1 meningioma, [[H&E stain]]. It is of the meningothelial histologic type, which is the most common meningioma type. It shows its typical findings:<br>- A woven architectural pattern<br>- Psammoma bodies (spheroid calcifications)<br>- Syncytial cells (having indistinct cell membranes) with eosinophilic (pink) cytoplasms<br>- Round uniform nuclei<br>- Whorls (concentric cell arrangements)<ref>Image by Mikael Häggström, MD. Reference for typical findings: {{cite web|url=https://www.pathologyoutlines.com/topic/cnstumormeningiomageneral.html|title=Meningioma|website=Pathology Outlines|author=Chunyu Cai, M.D., Ph.D.}} Last author update: 10 November 2021}}</ref>]]
[[File:Histopathology of meningioma.png|thumb|Histopathology of a typical WHO grade 1 meningioma, [[H&E stain]]. It is of the meningothelial histologic type, which is the most common meningioma type. It shows its typical findings:<br>- A woven architectural pattern<br>- Psammoma bodies (spheroid calcifications)<br>- Syncytial cells (having indistinct cell membranes) with eosinophilic (pink) cytoplasms<br>- Round uniform nuclei<br>- Whorls (concentric cell arrangements)<ref>Image by Mikael Häggström, MD. Reference for typical findings: {{cite web|url=https://www.pathologyoutlines.com/topic/cnstumormeningiomageneral.html|title=Meningioma|website=Pathology Outlines|author=Chunyu Cai, M.D., Ph.D.}} Last author update: 10 November 2021}}</ref>]]
===Squash prep===
====Squash prep====
Remove a drop-size sample, place it on a glass-slide, then gently smear it out with another glass slide, followed by applying a fixative solution and staining with H&E.
Remove a drop-size sample, place it on a glass-slide, then gently smear it out with another glass slide, followed by applying a fixative solution and staining with H&E.


;Evaluation
==Evaluation==
The most common primary brain tumors are:<ref>{{Cite book|title=Meningiomas: Diagnosis, Treatment, and Outcome| last1 = Park | first1 = Bong Jin | last2 = Kim | first2 = Han Kyu | last3 = Sade | first3 = Burak | last4 = Lee | first4 = Joung H. |publisher=Springer|year=2009|isbn=978-1-84882-910-7| veditors = Lee JH |page=11|chapter=Epidemiology}}
The most common primary brain tumors are:<ref>{{Cite book|title=Meningiomas: Diagnosis, Treatment, and Outcome| last1 = Park | first1 = Bong Jin | last2 = Kim | first2 = Han Kyu | last3 = Sade | first3 = Burak | last4 = Lee | first4 = Joung H. |publisher=Springer|year=2009|isbn=978-1-84882-910-7| veditors = Lee JH |page=11|chapter=Epidemiology}}
</ref>
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* Nerve sheath tumors (10%)
* Nerve sheath tumors (10%)
Also look into the patient's history for past cancers that may have metastasized to the brain.
Also look into the patient's history for past cancers that may have metastasized to the brain.
{|class=wikitable
|+Main brain tumors<ref>From notes by Dr. Kurt Schaberg, in turn citing: {{cite book | last=Perry | first=Arie | last2=Brat | first2=Daniel J. | title=Practical Surgical Neuropathology | publisher=Churchill Livingstone | publication-place=Philadelphia, PA | date=2017-12-07 | isbn=978-0-323-44941-0 | page=}}</ref>
! Location !! Child or young adult !! Older adult
|-
! Cerebral, supratentorial
| Ganglioglioma, dysembryoplastic neuroepithelial tumor (DNET), pleomorphic xanthoastrocytoma (PXA),
ependymoma, atypical teratoid/rhabdoid tumor (AT/RT), CNS embryonal neoplasms
| Glioblastoma, infiltrating astrocytoma (grades II-III), oligodendroglioma, metastasis, lymphoma, infection
|-
! Cerebellar, infratentorial, fourth ventricle
| Pilocytic astrocytoma, medulloblastoma, ependymoma, choroid plexus papilloma, atypical teratoid/rhabdoid tumor (AT/RT)
| Metastasis, hemangioblastoma, choroid plexus papilloma, subependymoma
|-
! Brainstem
| Pilocytic astrocytoma, diffuse midline glioma
| Astrocytoma, glioblastoma, diffuse midline glioma, metastasis
|-
! Spinal cord (intramedullary)
| Ependymoma, pilocytic astrocytoma, diffuse midline glioma, myxopapillary ependymoma, drop metastasis
| Ependymoma, astrocytoma, diffuse midline glioma, myxopapillary ependymoma (filum terminale), paraganglioma (filum terminale)
|-
! Spinal cord (extramedullary)
| Meningioma, schwannoma, metastasis, melanocytoma, melanoma
| Schwannoma, meningioma, melanocytoma, melanoma, malignant peripheral nerve sheath tumor (MPNST)
|-
! Spinal cord (extradural)
| Bone tumor, meningioma, abscess, vascular malformation,
| Herniated disk, lymphoma, abscess, metastases,
|-
! Extra-axial, dural, leptomeningeal
| Leukemia/lymphoma, Ewing sarcoma, rhabdomyosarcoma, disseminated medulloblastoma, diffuse leptomeningeal glioneuronal tumor (DLGNT),
| Meningioma, solitary fibrous tumor, metastasis, lymphoma
|-
! Sellar/infundibular
| Pituitary adenoma, craniopharyngioma, Rathke cleft cyst, pituicytoma, Langerhans cell histiocytosis (LCH), germ cell tumors
| Pituitary adenoma, craniopharyngioma, Rathke cleft cyst, pituicytoma, meningioma,
metastasis, chordoma
|-
! Suprasellar, hypothalamic, optic pathway, third ventricle
| Germ cell tumors, craniopharyngioma, pituitary adenoma, optic glioma, Langerhans cell histiocytosis (LCH)
| Colloid cyst, craniopharyngioma, chordoid glioma
|-
! Pineal
| Germ cell tumors, pineocytoma, pineoblastoma, pineal cyst
| Pineocytoma, pineal cyst, pineal parenchymal tumors of intermediate differentiation (PPTID)
|-
! Thalamus
| Pituitary adenoma, diffuse midline glioma
| Diffuse midline glioma, glioblastoma, lymphoma
|-
! Lateral ventricle
| Central neurocytoma, subependymal giant cell astrocytoma (SEGA), choroid plexus papilloma/carcinoma,
meningioma
| Central neurocytoma, subependymal giant cell astrocytoma (SEGA), choroid plexus papilloma/carcinoma, subependymoma, meningioma
|-
! Nerve root, paraspinal
| Neurofibroma, schwannoma, malignant peripheral nerve sheath tumor (MPNST)
| Neurofibroma, schwannoma, MPNST, lymphoma, meningioma
|-
! Cerebellopontine angle
| Schwannoma, Choroid plexus papilloma, atypical teratoid/rhabdoid tumor (AT/RT)
| Schwannoma, meningioma, epidermoid cyst, choroid plexus papilloma, endolymphatic sac tumor
|}
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Revision as of 22:07, 7 April 2024

Author: Mikael Häggström [note 1]

Intraoperative consultation of brain tumor fragments

Preparation

If you are expecting a brain/meningeal tumor, look at any radiology to find out what is the suspected diagnosis or differential diagnoses. A connection to the dura raises the suspicion of a meningioma. Multiple tumors raises the suspicion of metastasis or lymphoma.

Grossing

File:Gross pathology of melanoma metastasis.jpg
Resected fragments of a brain tumor, and in this case the very dark appearance supports a diagnosis of metastatic pigment-forming melanoma.

Measure the size of the specimen in 3 dimensions.

File:Histopathology of meningioma.png
Histopathology of a typical WHO grade 1 meningioma, H&E stain. It is of the meningothelial histologic type, which is the most common meningioma type. It shows its typical findings:
- A woven architectural pattern
- Psammoma bodies (spheroid calcifications)
- Syncytial cells (having indistinct cell membranes) with eosinophilic (pink) cytoplasms
- Round uniform nuclei
- Whorls (concentric cell arrangements)[1]

Squash prep

Remove a drop-size sample, place it on a glass-slide, then gently smear it out with another glass slide, followed by applying a fixative solution and staining with H&E.

Evaluation

The most common primary brain tumors are:[2]

Also look into the patient's history for past cancers that may have metastasized to the brain.

Main brain tumors[4]
Location Child or young adult Older adult
Cerebral, supratentorial Ganglioglioma, dysembryoplastic neuroepithelial tumor (DNET), pleomorphic xanthoastrocytoma (PXA),

ependymoma, atypical teratoid/rhabdoid tumor (AT/RT), CNS embryonal neoplasms

Glioblastoma, infiltrating astrocytoma (grades II-III), oligodendroglioma, metastasis, lymphoma, infection
Cerebellar, infratentorial, fourth ventricle Pilocytic astrocytoma, medulloblastoma, ependymoma, choroid plexus papilloma, atypical teratoid/rhabdoid tumor (AT/RT) Metastasis, hemangioblastoma, choroid plexus papilloma, subependymoma
Brainstem Pilocytic astrocytoma, diffuse midline glioma Astrocytoma, glioblastoma, diffuse midline glioma, metastasis
Spinal cord (intramedullary) Ependymoma, pilocytic astrocytoma, diffuse midline glioma, myxopapillary ependymoma, drop metastasis Ependymoma, astrocytoma, diffuse midline glioma, myxopapillary ependymoma (filum terminale), paraganglioma (filum terminale)
Spinal cord (extramedullary) Meningioma, schwannoma, metastasis, melanocytoma, melanoma Schwannoma, meningioma, melanocytoma, melanoma, malignant peripheral nerve sheath tumor (MPNST)
Spinal cord (extradural) Bone tumor, meningioma, abscess, vascular malformation, Herniated disk, lymphoma, abscess, metastases,
Extra-axial, dural, leptomeningeal Leukemia/lymphoma, Ewing sarcoma, rhabdomyosarcoma, disseminated medulloblastoma, diffuse leptomeningeal glioneuronal tumor (DLGNT), Meningioma, solitary fibrous tumor, metastasis, lymphoma
Sellar/infundibular Pituitary adenoma, craniopharyngioma, Rathke cleft cyst, pituicytoma, Langerhans cell histiocytosis (LCH), germ cell tumors Pituitary adenoma, craniopharyngioma, Rathke cleft cyst, pituicytoma, meningioma,

metastasis, chordoma

Suprasellar, hypothalamic, optic pathway, third ventricle Germ cell tumors, craniopharyngioma, pituitary adenoma, optic glioma, Langerhans cell histiocytosis (LCH) Colloid cyst, craniopharyngioma, chordoid glioma
Pineal Germ cell tumors, pineocytoma, pineoblastoma, pineal cyst Pineocytoma, pineal cyst, pineal parenchymal tumors of intermediate differentiation (PPTID)
Thalamus Pituitary adenoma, diffuse midline glioma Diffuse midline glioma, glioblastoma, lymphoma
Lateral ventricle Central neurocytoma, subependymal giant cell astrocytoma (SEGA), choroid plexus papilloma/carcinoma,

meningioma

Central neurocytoma, subependymal giant cell astrocytoma (SEGA), choroid plexus papilloma/carcinoma, subependymoma, meningioma
Nerve root, paraspinal Neurofibroma, schwannoma, malignant peripheral nerve sheath tumor (MPNST) Neurofibroma, schwannoma, MPNST, lymphoma, meningioma
Cerebellopontine angle Schwannoma, Choroid plexus papilloma, atypical teratoid/rhabdoid tumor (AT/RT) Schwannoma, meningioma, epidermoid cyst, choroid plexus papilloma, endolymphatic sac tumor

Notes

  1. ↑ For a full list of contributors, see article history. Creators of images are attributed at the image description pages, seen by clicking on the images. See Patholines:Authorship for details.

Main page

References

  1. ↑ Image by Mikael Häggström, MD. Reference for typical findings: Chunyu Cai, M.D., Ph.D.. Meningioma. Pathology Outlines. Last author update: 10 November 2021}}
  2. ↑ Park, Bong Jin; Kim, Han Kyu; Sade, Burak; Lee, Joung H. (2009). "Epidemiology". Meningiomas: Diagnosis, Treatment, and Outcome . Springer. p. 11. ISBN 978-1-84882-910-7. 
  3. ↑ 3.0 3.1 3.2 . Brain Tumors - Classifications, Symptoms, Diagnosis and Treatments (in en). www.aans.org.
  4. ↑ From notes by Dr. Kurt Schaberg, in turn citing: Perry, Arie; Brat, Daniel J. (2017-12-07). Practical Surgical Neuropathology . Philadelphia, PA: Churchill Livingstone. ISBN 978-0-323-44941-0. 

Image sources


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